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. 2025 Jun 11.
doi: 10.1007/s00405-025-09516-4. Online ahead of print.

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

Donata Sukyte-Raube  1 , Davide Locatelli  2 , Paolo Castelnuovo  3 , Mustafa Haseeb Alali  4 , Eugenijus Lesinskas  5
Affiliations

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

Donata Sukyte-Raube et al. Eur Arch Otorhinolaryngol. .

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.

Keywords: Endocrinological remission; Endoscopic diving technique; Endoscopic endonasal pituitary surgery; Radiological remission.

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Conflict of interest statement

Declarations. All the authors certify that they have no conflict of interest or financial relationship with any entity mentioned in the paper. Ethics statement: The studies involving human participants were reviewed and approved by Lithuanian Bioethics Committee (No.2021/6–1362-836). Written informed consent for participation was required for this study in accordance with the national legislation and the institutional requirements.

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