Is endoscopic diving technique effective in surgical management of functioning pituitary adenomas? A prospective randomized study.

Abstract

Purpose: This study aimed to evaluate the effectiveness of the Endoscopic Diving Technique (EDT) as an adjunct to endoscopic endonasal transsphenoidal surgery in improving remission rates in patients with functional pituitary adenomas. The primary research question was whether EDT enhances early endocrinological and radiological remission without increasing surgical complications.

Methods: A prospective randomized trial was conducted at Vilnius University Hospital Santaros Klinikos between 2021 and 2023, with 141 patients diagnosed with functional pituitary adenomas. Seventy-eight patients met inclusion criteria and were randomly assigned to either the EDT group (n = 43), which included an additional endoscopic hydroscopy step, or the non-EDT group (n = 35). Follow-up assessments were performed at 3, 12, and 24 months to evaluate endocrinological and radiological remission. Additional parameters analyzed included surgical complications, operative duration, and water volume used for EDT.

Results: The EDT group demonstrated significantly higher early endocrine remission rates (83.7% vs. 60.0%, p = 0.023) and fewer radiological relapses at 3 months (86.0% vs. 68.6%, p = 0.097), 12 months (81.4% vs. 62.9%, p = 0.078), and 24 months (69.8% vs. 42.9%, p = 0.022). Surgical complication rates were comparable between the groups (4.7% vs. 2.9%, p = 1.000).

Conclusion: The implementation of EDT as an adjunct to transsphenoidal surgery is associated with improved endocrinological and radiological remission rates in functional pituitary adenomas without increasing surgical risk. EDT enhances visualization of the sellar cavity, facilitates tumor removal, and reduces venous hemorrhage, making it a valuable addition to standard surgical practice.