Transseptal Microscopic vs. Endoscopic Transsphenoidal Surgery Comparison
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Preliminary Comparison of Transseptal Microscopic Versus Endoscopic Transsphenoidal Surgery in a University Teaching Hospital
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Zaitun Zakaria, Zamzuri Idris, Jafri Malin Abdullah, Baharudin Abdullah, Abdul Rahman Izaini Ghani
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Preliminary Comparison of Transseptal Microscopic Versus Endoscopic Transsphenoidal Surgery in a University Teaching Hospital
Year: 2022 | Doi: 10.21315/mjms2022.29.1.7
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Transsphenoidal surgery (TSS) has become increasingly favored for the treatment of sella lesions, particularly with the growing adoption of endoscopic techniques alongside traditional microscopic approaches. This study evaluates the outcomes from a single institution comparing endoscopic TSS and transseptal microscopic TSS, with a focus on demographic characteristics, surgical outcomes, complication rates, and visual assessments post-surgery. The increasing interest in minimally invasive surgical methods has led to significant advancements in the techniques employed by neurosurgeons to access the sellar and suprasellar regions.
Complication Rates: A Notable Concern
The research indicated that while endoscopic TSS provides sufficient visualization of the surgical field, it is associated with a higher rate of complications compared to microscopic TSS. Specifically, patients undergoing endoscopic TSS exhibited a significantly increased risk of postoperative complications such as epistaxis, respiratory events, and visual deterioration prior to discharge. The learning curve associated with mastering endoscopic techniques is suggested as a contributing factor to these higher complication rates. Conversely, microscopic TSS showed a lower rate of complications, highlighting both the efficacy of the traditional approach and the challenges faced in the transition to newer surgical methodologies.
Conclusion
In conclusion, while endoscopic TSS presents promising advantages in surgical visualization and access, it also poses heightened risks of complications, particularly during the early adoption phase in surgical practice. The findings suggest an urgent need for continued training and evaluation of the endoscopic approach to enhance surgical proficiency and patient outcomes. This comparative study informs ongoing efforts to refine both surgical methods within teaching hospitals, aiming to optimize patient safety and recovery in neurosurgical procedures.
FAQ section (important questions/answers):
What is transsphenoidal surgery (TSS) and its types?
Transsphenoidal surgery (TSS) is a minimally invasive technique used to remove pituitary tumors. The two main types are microscopic TSS, which uses a microscope for visualization, and endoscopic TSS, which uses an endoscope for enhanced view and access.
What were the demographics of the studied patients undergoing TSS?
The study included 56 patients (31 men, 25 women) with a median age of 49 years. Patients underwent either microscopic or endoscopic TSS, showing no significant pre-operative differences regarding demographics or symptoms.
What were the main findings regarding complications from both TSS techniques?
The endoscopic TSS group experienced higher rates of epistaxis, respiratory events, and visual deterioration compared to the microscopic group. Overall complication rates were greater in the endoscopic group, reflecting the learning curve associated with the technique.
How does the effectiveness of endoscopic TSS compare to microscopic TSS?
Both techniques were comparable in terms of tumor removal effectiveness, but microscopic TSS showed a trend towards better tumor volume reduction. However, endoscopic TSS is associated with a steeper learning curve and higher complication rates.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Transseptal Microscopic vs. Endoscopic Transsphenoidal Surgery Comparison”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Post:
Post refers to the period following a specific event. In medical studies, post-operative conditions, assessments, or complications are crucial for analyzing the outcomes of surgical procedures. It allows clinicians to monitor recovery, complications, and overall effectiveness of treatment interventions after surgery, providing insights for future practices.
2) Table:
In this context, 'Table' refers to a structured representation of data, typically used for summarizing findings in research studies. Tables help present demographic, statistical, or qualitative data in an organized manner, making it easier for readers to comprehend research results, trends, and comparisons across study groups.
3) Study (Studying):
A study is a systematic investigation aimed at acquiring knowledge about a particular subject. In medical contexts, it often refers to clinical trials or research that evaluates treatment efficacy, patient outcomes, or disease management strategies, contributing invaluable data that can influence medical practices and healthcare policies.
4) Field:
Field can refer to a specific area of study or practice, particularly in medicine and research. In surgical context, it can relate to the surgical field, which is the operating area where medical procedures are performed. Good visibility and access in the surgical field are vital for successful outcomes.
5) Teaching:
Teaching refers to the process of imparting knowledge or skills, particularly in clinical training environments. In surgery, teaching residents and medical students is essential for cultivating the next generation of surgeons, ensuring they acquire the necessary expertise and experience to perform complex procedures safely and competently.
6) Male:
Male denotes a gender classification that is typically associated with specific biological characteristics. In medical research, recognizing gender differences among participants (like male vs. female) is crucial, as it can influence the prevalence of diseases, treatment responses, and outcomes, leading to more tailored and effective healthcare strategies.
7) Antibiotic (Antibacterial):
An antibiotic is a type of medication used to treat bacterial infections. In surgery, prophylactic antibiotics may be administered to prevent post-operative infections, which can significantly affect recovery outcomes. Understanding the appropriate use and potential resistance patterns of antibiotics is essential in modern medical practice.
8) Learning:
Learning is the process of acquiring new knowledge or skills through experience, study, or teaching. In the context of surgical techniques, continuous learning is vital for surgeons, allowing them to adapt to new methods, technologies, and evidence-based practices, ultimately improving patient care and surgical outcomes.
9) Patel:
Patel may refer to a specific author or researcher in the context of the study. In academic citations, author names are crucial for attributing credit for research findings, and recognizing contributions enhances the credibility of the work, allowing readers to trace back the origins of specific insights and conclusions.
10) Rules:
Rules denote established guidelines or principles that dictate the protocols of practice in various domains, including medicine. In clinical studies, adherence to rules regarding data collection, methodology, and ethical considerations ensures the validity, reliability, and reproducibility of research findings, ultimately contributing to scientific integrity.
11) Blood:
Blood is a vital fluid in the body, essential for transporting oxygen, nutrients, and waste products. In medical contexts, blood considerations, including transfusion requirements, bleeding complications, and coagulation status, are critical during and after surgical procedures, impacting patient recovery and overall outcomes.
12) Bleeding:
Bleeding refers to the loss of blood from the vascular system, either externally or internally. In surgery, managing bleeding is crucial, as excessive blood loss can lead to complications such as shock or prolonged recovery. Understanding bleeding risks and control measures is essential for surgical success.
13) Repair:
Repair in a medical context refers to the methods and techniques used to restore normal function or structure to damaged tissues or organs. In surgical procedures, repair is a fundamental aspect, addressing complications such as defects or injuries, enabling the restoration of anatomical integrity and function.
14) Arrangement:
Arrangement refers to the organization or layout of specific items or structures. In surgical settings, proper arrangement of instruments, surgical teams, and patient positioning can significantly influence the efficiency and safety of the operation, ensuring that all necessary components are in their proper places during procedures.
15) Knowledge:
Knowledge encompasses the information and understanding gained through experience or education. In medicine, it is crucial for making informed decisions regarding patient care, treatment options, and surgical techniques. Continuous accumulation of knowledge contributes to advancing medical practice, improving patient outcomes, and enhancing overall healthcare quality.
16) Evolution:
Evolution refers to the gradual development or changes in a particular field, often related to advancements in techniques, technologies, or understandings over time. In medical and surgical contexts, recognizing the evolution of methodologies is essential for incorporating evidence-based practices and improving patient outcomes based on accumulated experiences.
17) Incision:
An incision is a precise cut made in the skin or other tissues during a surgical procedure. The technique and location of an incision can impact healing, recovery time, and overall surgical outcomes, making surgeon mastery of incision methods a critical component of surgical practice.
18) Nostril:
Nostril refers to the external openings of the nasal cavity, which are significant in transsphenoidal surgery. Surgeons utilize nostrils for access during endoscopic approaches, making knowledge of nostril anatomy and surrounding structures essential for performing procedures successfully and minimizing complications.
19) Gelatin:
Gelatin is a substance often used in medical contexts as a hemostatic agent or for structural support in surgical repairs. In surgery, it may be used to create barriers or scaffolds in tissue reconstruction, assisting with hemostasis, tissue adhesion, and promoting healing post-surgery.
20) Prabhu:
Prabhu might refer to a researcher, doctor, or author cited in the study. Author names are essential for proper attribution and recognition in academic writing, allowing others to locate and reference the work easily, contributing to the broader scientific conversation and understanding in the field.
21) India:
India may indicate the geographical context of the study, suggesting where the research was conducted or the population involved. Understanding the regional context is crucial in medical research, as it influences health outcomes, access to healthcare, and the application of findings to specific populations or cultural settings.
22) Visit:
A visit refers to an instance of seeing or consulting a patient in a medical context. In research, documenting visits helps track patient progress, post-operative assessments, and the effectiveness of treatments. Visits are fundamental for ongoing patient management and ensuring comprehensive care.
23) Ter:
Ther likely refers to a shorthand or an abbreviation within the context of certain medications or therapies. In medical studies, specific therapies are crucial for treatment protocols and analyzing efficacy and outcomes related to particular diseases or conditions across the treatment spectrum.
24) Calculation:
Calculation involves determining numerical results based on collected data, such as statistical analyses. In research, accurate calculations are essential for interpreting findings, assessing significance, and making evidence-based conclusions. The validity of calculations directly impacts the reliability of research outcomes.
25) Reliability:
Reliability refers to the consistency and dependability of a study's results. In research, high reliability indicates that findings can be replicated and are trustworthy. It is essential for establishing the credibility of studies and supporting clinical decisions based on sound evidence.
26) Discussion:
Discussion is an important section of a research paper where authors interpret their findings, compare with existing literature, and explore implications. It provides insights into the significance of results and contextualizes the study within broader scientific discourse, influencing future research directions and clinical practices.
27) Harvesting (Harvest):
Harvesting refers to the collection or gathering of materials, such as tissues or cells for medical purposes. In a surgical context, harvesting techniques are essential for creating grafts or repairs, impacting surgical outcomes and patient recovery. Understanding harvesting protocols is crucial for successful surgical interventions.
28) Training:
Training involves the education and skill acquisition necessary for medical professionals to perform their duties effectively. In the surgical context, proper training ensures that residents and surgeons develop the expertise required to handle complex procedures and manage potential complications proficiently.
29) Relative:
Relative can imply the comparison or positioning of one condition with another. In medical research, relative outcomes (e.g., relative risk) help quantify the differences between treatment groups, aiding in determining the efficacy and safety of various medical interventions.
30) Disease:
Disease refers to any health condition characterized by specific symptoms or dysfunctions. In medical research, understanding disease mechanisms is critical for developing effective treatments and interventions. The nature of the disease influences the design and outcomes of clinical studies.
31) Family:
Family may refer to the support system surrounding patients, which plays a significant role in healthcare outcomes. Understanding family dynamics and involvement is essential for managing patient care, especially in contexts requiring ongoing support and education during recovery from surgical procedures.
32) Reason:
Reason pertains to the justification or rationale behind clinical decisions, choices of intervention, or research conclusions. In healthcare, identifying the reason for specific treatment approaches can enhance understanding, improve patient compliance, and foster trust between patients and healthcare professionals.
33) Desire:
Desire expresses the motivation or intent behind actions, such as pursuing advanced techniques in surgery. In a medical context, desire for innovation and improvement drives healthcare professionals to adopt new methodologies, advancing patient care and overall surgical success.
34) Arrow:
Arrow may not directly connect with medical terminology but could symbolize directionality or aim in a research context. It often represents targeted outcomes in studies, indicating a goal or focus on achieving precise, objective results in patient care and medical interventions.
35) Death:
Death signifies the cessation of life, often a critical endpoint in medical studies. Understanding mortality rates and associated factors in research helps identify risks and improve clinical outcomes by examining definitive measures of treatment effectiveness and patient well-being.
36) Beta:
Beta might refer to specific parameters in statistical analyses (like beta coefficients) or the classification of certain medications. In medical literature, identifying beta parameters helps understand relationships between variables and patient responses to treatments, influencing research conclusions and healthcare practices.
37) Pari:
Pari may indicate a contextually relevant name or term that could refer to a researcher, author, or specific study group. Proper attribution to named individuals or entities enhances the credibility of research findings, aiding in clearer academic communication and referencing.
38) Wall:
Wall can refer to anatomical barriers or structures relevant in surgical contexts, such as the bony walls of the skull. Understanding wall structures is crucial for navigating surgical spaces, minimizing injury, and ensuring successful outcomes in various surgical procedures.
39) Pur:
Poor may describe health status, indicating a lower level of overall well-being or high morbidity. In research, categorizing patients based on poor health can influence treatment protocols and outcomes, stressing the importance of considering socio-economic factors and health disparities in medical studies.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Transseptal Microscopic vs. Endoscopic Transsphenoidal Surgery Comparison’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Uti, Total, Resident, Mortality, Permanent, Best practice, Surgical operation, Patient care, Data collection, Blood transfusion, Loss of vision, Transient, Conflict of interest, Craniotomy, Haemorrhage, Data analysis, Panoramic view, Optic nerve, Hospital admission, Statistical Significance, Morbidity and Mortality, Visual acuity, Meta analysis, Systematic Review, Surgical Procedure, Deep vein thrombosis, General condition, Pre operative, Post operative, No improvement, Prospective study, Urinary tract infection, Radiological findings, Selection bias, Synthetic material, Magnetic resonance imaging, Length of stay, Standard deviation, Post-operative assessment, Intensive care unit, Post-operative care, Neuroanatomy, Nasal Mucosa, Cerebrospinal Fluid, Hospital stay, Rhinosinusitis, Prophylactic Antibiotic, Sepsis, Microscopic surgery, Computed tomography, Surgical technique, Acromegaly, Pulmonary embolism, Intensive care, Hospital-acquired pneumonia, Male Female Ratio, General anaesthesia, Median age, Cerebral vasospasm, Smoking, Tranexamic acid, Patient Outcome, Prolonged hospital stay, Comparable results, Microscopic technique, Tumour volume, Pituitary adenoma, Diabetes insipidus, Visual assessment, Complication rate, Intracranial Pressure, Polypectomy, Neurosurgery department, Pre operative assessment, Surgical field, Transsphenoidal Surgery, Learning curve, Respiratory complications, CT Brain, Neurosurgeon, University Teaching Hospital, Operating theatre, Surgical complication, Tracheostomy, Epistaxis, Histopathological diagnosis, Sleep Apnoea, Haematoma, Pre-operative care, Volume reduction, Nasal septum, Septicaemia, Complete resection, Mucosal bleeding, Post operative complication, Pituitary tumor, Endoscopic approach, Operating microscope, Tissue graft, Hospital Universiti Sains Malaysia, Endoscopic surgery, Suprasellar region, Tumor removal, Pre-operative volume, Rigid endoscope, Tracheal extubation, Intraventricular haemorrhage, Sphenoid sinus, Total resection, Categorical variable, Residual tumour, Operating time, Endoscopic transsphenoidal surgery, Three-dimensional vision, Endoscopic TSS, Microscopic TSS, Sella lesions, Cerebrospinal fluid fistula, Endocrinological assessments, Neuro-ophthalmological assessments, Pituitary hormone deficiency, Post-operative visual deterioration, Significant risk, Epistaxis risk, Visualisation of the surgical field, Critical revision, Post-operative outcomes, Tertiary Care, Observe, Authors contribution, Immediate post operative complications, Resistant organism, Sphenopalatine artery, Medical complication, Binocular vision, Tumour removal, Conception and design, Drafting of the article, Single centre, Final approval, Provision of study materials, Analysis and interpretation, Raised intracranial pressure, Anterior skull base, External ventricular drain, Medical record, Non-functioning pituitary macroadenoma, Demographic characteristic, Collection and assembly, Internal carotid artery, Continuous variable, Normal, Short-term outcome, AbstractBackgroundTranssphenoidal, Retrospective data analysis, Intra-operative analyses, Steep learning curve, Sellar and suprasellar, Transnasal transsphenoidal surgery, Pneumatic cavities, Hermann Schloffer, Harvey Cushing, Oskar Hirsch, Norman Dott, Gerard Guiot, Jules Hardy, French otolaryngologists, Pituitary protocol, High-speed drill, Image-guided surgery, Endoscopic technique, Middle turbinate, Sellar reconstruction, Cavernous sinus injury, Pneumocephalus, AbstractBackgroundTranssphenoidal surgery, CSF fistula, Sinus complications, Respiratory event, Sellar and suprasellar region, Otorhinolaryngologist, Sellar floor, Dura incision, Lumbar drain, Visual deterioration, Anterior pituitary hormone deficiency, Endoscopic TSS is a promising procedure, Minimally invasive extra-cerebral approach, Transnasal transsphenoidal surgery (TSS), Endoscopic TSS is newly introduced, Minimise the selection bias, Hadad flap, Endoscopic group, Microscopic group, Intracranial pressure symptoms, Suppressive medical therapy, Post-operative volume reduction, Complete tumour resection, Intra-operative CSF leak, Elective lumbar drain, Overnight ventilation, Post-operative CSF fistula, Post-operative volume, Lumbar drainage, External ventricular drain (EVD), Intracranial pressure (ICP) symptoms, Post-operative MRI brain, Transnasal repair, Tissue grasper, Bitemporal hemianopia, Sella turcica, Otorrhinolaryngologist, Transnasal closure, Harvesting graft, Transnasal evacuation, General complications, Intravascular catheter related infection, CNS event, Cardiac event, Exposure keratopathy, Total events, Visual field deficits, Visual acuity and field deficits, Acetazolamide medication, Prolonged intubation, Patient comorbidity, Pre-operative workups, Optic chiasm, Suprasellar cistern, Vascular elements, Empty sella, Tumour volume reduction, Tumour remnants, Lateral spaces, Angle views, Access routes, Monocular vision, Radical undertakings, Risk and benefit, Clinical sequelae, Posterior nasal branch, Persistent haemorrhage, OT time, Klebsiella pneumoniae carbapenem-resistant enterobacteriaceae, Pseudomonas aeruginosa CRE, Escherichia coli extended spectrum beta-lactamases, Type 1 respiratory failure, Tumour pathology, Major arteries, General complication rates, Pituitary surgery, Microscopic approach, Pituitary adenoma surgery, Skull base surgery, Concurrent series, Revision transsphenoidal surgeries, Pre-operative lumbar drain, Intra-operative lumbar drain, Optimal surgical techniques, Endoscopic versus microscopic, Transsphenoidal pituitary surgery, Primary and revision, Modern criteria, Intra-operative lumbar, Complications after transsphenoidal, Skull base tumor, Non-functioning pituitary, Pre-operative tumour volume, Higher complication rate, Anatomical elements, Anterior pituitary hormone, Sella floor, Complete tumor resection, Mortality and visual assessments, Post-operative tumour volumes, Tumour was removed, Sella defect, Otorhinolaryngologist facilitated, Sphenoidotomy, Dural matter, Gentle suction, Autologous or heterologous, Microsurgical TSS, Previous transsphenoidal operations, Persistent mucosal bleeding, Sella haematoma, Worse, Somewhat improved, Resolved, Microsurgical group, Pre-operative visual assessments, Post-operative visual assessment, Microsurgical, Endoscopic, Minimally invasive surgeries, Intra-operative haemorrhages, Post-operative CT brain, Vision after transsphenoidal, Microsurgical transsphenoidal surgery, Primary and revision transsphenoidal surgeries, Lumbar drain placement, Surgical techniques for, Transsphenoidal surgeries, Endoscopic skull base, Microscopic transsphenoidal surgery, Transsphenoidal pituitary, Endoscopic versus microscopic approach, Endoscopic transsphenoidal pituitary, Short-term outcome of, Complications of transsphenoidal surgery.