TY - JOUR
T1 - Three-hand endoscopic endonasal transsphenoidal surgery
T2 - Experience with an anatomy-preserving mononostril approach technique
AU - Eseonu, Chikezie I.
AU - ReFaey, Karim
AU - Pamias-Portalatin, Eva
AU - Asensio, Javier
AU - Garcia, Oscar
AU - Boahene, Kofi D.
AU - Quiñones-Hinojosa, Alfredo
N1 - Publisher Copyright:
© 2017 by the Congress of Neurological Surgeons.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - BACKGROUND: Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. OBJECTIVE: To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. METHODS: Prospective case series and retrospective data analysis of patients who were treatedwith the 3-hand transsphenoidal technique between January 2007 andMay 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. RESULTS: Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3min, P =.001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P =.846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. CONCLUSION:We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized.
AB - BACKGROUND: Variations on the endoscopic transsphenoidal approach present unique surgical techniques that have unique effects on surgical outcomes, extent of resection (EOR), and anatomical complications. OBJECTIVE: To analyze the learning curve and perioperative outcomes of the 3-hand endoscopic endonasal mononostril transsphenoidal technique. METHODS: Prospective case series and retrospective data analysis of patients who were treatedwith the 3-hand transsphenoidal technique between January 2007 andMay 2015 by a single neurosurgeon. Patient characteristics, preoperative presentation, tumor characteristics, operative times, learning curve, and postoperative outcomes were analyzed. Volumetric EOR was evaluated, and a logistic regression analysis was used to assess predictors of EOR. RESULTS: Two hundred seventy-five patients underwent an endoscopic transsphenoidal surgery using the 3-hand technique. One hundred eighteen patients in the early group had surgery between 2007 and 2010, while 157 patients in the late group had surgery between 2011 and 2015. Operative time was significantly shorter in the late group (161.6 min) compared to the early group (211.3min, P =.001). Both cohorts had similar EOR (early group 84.6% vs late group 85.5%, P =.846) and postoperative outcomes. The learning curve showed that it took 54 cases to achieve operative proficiency with the 3-handed technique. Multivariate modeling suggested that prior resections and preoperative tumor size are important predictors for EOR. CONCLUSION:We describe a 3-hand, mononostril endoscopic transsphenoidal technique performed by a single neurosurgeon that has minimal anatomic distortion and postoperative complications. During the learning curve of this technique, operative time can significantly decrease, while EOR, postoperative outcomes, and complications are not jeopardized.
KW - Learning curve
KW - Mononostril
KW - Pituitary adenoma
KW - Transsphenoidal
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U2 - 10.1093/ons/opx110
DO - 10.1093/ons/opx110
M3 - Article
C2 - 29351688
AN - SCOPUS:85041519604
SN - 2332-4252
VL - 14
SP - 158
EP - 165
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 2
ER -