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The operative advantages of 4K ultra-high definition endoscope in pituitary surgery: analysis of a comparative institutional case series
EANS Academy. Mattogno P. 09/26/19; 276124; EP04119
Dr. Pier Paolo Mattogno
Dr. Pier Paolo Mattogno

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Abstract
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Background: Trans-sphenoidal endoscopic surgery has drawn huge benefits from recent technical advances in surgical visualization. The Ultra-HD 4K endoscope has improved 4-fold image resolution compared with HD endoscopes, but its actual clinical advantages are still unclear. The aim of the present study was to assess the usefulness of 4K endoscope in trans-sphenoidal pituitary surgery.
Methods: We analyzed a series of 121 trans-sphenoidal procedures for pituitary adenoma performed by an experienced skull base team using alternatively the HD (n=64) or the 4K (n=57) endoscopes. We evaluated extent of resection both subjectively, based on intraoperative surgeon's impression, and objectively based on post-operative MR scan.
Results: Baseline patients characteristics were well balanced between the two groups. Objective total resection rate was comparable between 4K and HD groups (60.7% vs 50%). 4K endoscope improved the resection rate in more challenging cases, though this evidence did not reach statistical significance. At multivariate analysis, the only independent prognosticator of total resection was cavernous sinus invasion. Importantly, the use of 4K endoscope enhanced the reliability of surgeon's intraoperative judgement on extent of resection, by significantly reducing the occurrence of an unexpected residual disease (17.9% vs 42.2% in HD group). This evidence was confirmed at multivariate analysis. Length of surgery, complications rate and post-operative endocrine and ophthalmological outcomes were similar between the two groups, whereas length of stay was shorter in 4K group.
Conclusions: The use of 4K endoscope improved the reliability of surgeon's judgment on extent of resection. In addition, we suggest that the 4K enhanced visualization could be particularly useful in surgically difficult cases. Whether this tool actually improves patients' outcome or eases the learning curve in endoscopic pituitary surgery remains to be determined.
Background: Trans-sphenoidal endoscopic surgery has drawn huge benefits from recent technical advances in surgical visualization. The Ultra-HD 4K endoscope has improved 4-fold image resolution compared with HD endoscopes, but its actual clinical advantages are still unclear. The aim of the present study was to assess the usefulness of 4K endoscope in trans-sphenoidal pituitary surgery.
Methods: We analyzed a series of 121 trans-sphenoidal procedures for pituitary adenoma performed by an experienced skull base team using alternatively the HD (n=64) or the 4K (n=57) endoscopes. We evaluated extent of resection both subjectively, based on intraoperative surgeon's impression, and objectively based on post-operative MR scan.
Results: Baseline patients characteristics were well balanced between the two groups. Objective total resection rate was comparable between 4K and HD groups (60.7% vs 50%). 4K endoscope improved the resection rate in more challenging cases, though this evidence did not reach statistical significance. At multivariate analysis, the only independent prognosticator of total resection was cavernous sinus invasion. Importantly, the use of 4K endoscope enhanced the reliability of surgeon's intraoperative judgement on extent of resection, by significantly reducing the occurrence of an unexpected residual disease (17.9% vs 42.2% in HD group). This evidence was confirmed at multivariate analysis. Length of surgery, complications rate and post-operative endocrine and ophthalmological outcomes were similar between the two groups, whereas length of stay was shorter in 4K group.
Conclusions: The use of 4K endoscope improved the reliability of surgeon's judgment on extent of resection. In addition, we suggest that the 4K enhanced visualization could be particularly useful in surgically difficult cases. Whether this tool actually improves patients' outcome or eases the learning curve in endoscopic pituitary surgery remains to be determined.
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