Stereoscopic Three-Dimensional Endoscopic Pituitary Surgery

Introduction: The endoscope provides several advantages over the microscope in the visualization of intra- and suprasellar pituitary tumors including the proximity of the lens to the target, the panoramic view, and the ability to see around corners. However, many neurosurgeons not trained in these techniques are reluctant to make the transition, arguing that the loss of stereoscopic vision and depth perception renders endoscopic visualization inferior to the microscope. Recently, three-dimensional endoscopic surgery has become possible with the development of a miniature stereoscopic camera (Visionsense Ltd., Petach Tikva, Israel). Previously tested in laparoscopic surgery, we report the first cases of 3-D endoscopic pituitary surgery.

Methods: Prospective study of 3-D endoscopic pituitary surgery performed between August 2006 and January 2007.

Results: Following a trial in the cadaver laboratory, seven patients had surgery carried out using stereoscopic 3-D endoscopy. All patients had pituitary tumors limited to the sella or with limited suprasellar extent. Surgeries were completed with a 6.5-mm 3-D stereoscopic 0-degree endoscope. There were no intraoperative or postoperative complications noted during the study. Qualitative assessments by the surgical team included improved depth perception, better recognition of anatomic structures, and improved visualization of the tumor bed.

Conclusion: 3-D endoscopic pituitary surgery is feasible and useful. Potential advantages include a decreased learning curve for neurosurgeons and improved depth perception. Further study is warranted as this technology may facilitate the adoption of the endoscope into common neurosurgical practice. Future technical improvements include 3-D endoscopes that are angled and have a narrower diameter.