The role of outcomes data for assessing the expertise of a pituitary surgeon.

PURPOSE OF REVIEW: Over the past four decades, advances in surgical technique, instrumentation, and anatomical knowledge have fueled the evolution and sophistication of transsphenoidal pituitary surgery. Paralleling these advances have been major improvements in endocrinological and overall clinical outcomes in patients with pituitary adenomas and other parasellar lesions such as Rathke's cleft cysts and craniopharyngiomas. In this review, we assess the impact of neurosurgeon expertise as a determinant of outcome in pituitary surgery. RECENT FINDINGS: Published data since the 1980s indicate that remission rates, overall clinical outcomes and surgical complication rates in pituitary and parasellar surgery are related to neurosurgeon practice volume and cumulative clinical experience. More recently, pituitary surgery has been increasingly performed using an endonasal endoscopic approach. Reports over the last decade suggest when an experienced pituitary neurosurgeon performs a fully endoscopic or endoscope-assisted tumor removal; outcomes are similar if not better than when performed by a traditional microscopic transsphenoidal approach. SUMMARY: A focused clinical practice and large transsphenoidal surgical volume appear to be important outcome determinants for patients with pituitary and parasellar tumors. Strategies that may further improve patient outcomes include establishing guidelines for pituitary tumor centers of excellence and more focused residency and fellowship training in endonasal endoscopic transsphenoidal surgery. Encouraging regionalization of care to higher volume pituitary tumor centers of excellence and promoting patient education on the importance of surgical expertise may further enhance pituitary patient outcomes.

European endocrine surgery in the 150-year history of Langenbeck's Archives of Surgery.

INTRODUCTION: Founded in 1861 as a German language scientific forum of exchange for European surgeons, Langenbeck's Archives of Surgery quickly advanced to become the premier journal of thyroid surgery before World War I, serving as a point of crystallization for the emerging discipline of endocrine surgery. During the interwar period and, in particular, in the first decades after World War II, Langenbeck's Archives of Surgery lost its dominant position as an international and European medium of publication of top quality articles in the area of endocrine surgery. Nevertheless, the journal remained the chief publication organ of German language articles in the field of endocrine surgery. After a series of key events, Langenbeck's Archives of Surgery managed to reclaim its former position as the leading European journal of endocrine surgery: (1) the formation of endocrine surgery in the early 1980s as a subdiscipline of general and visceral surgery; (2) the change of the language of publication from German to English in 1998; and (3) the journal's appointment in 2004 as the official organ of publication of the European Society of Endocrine Surgeons. CONCLUSION: All in all, the 150-year publication record of Langenbeck's Archives of Surgery closely reflects the history of European Endocrine Surgery. Following the path of seminal articles from Billroth, Kocher, and many other surgical luminaries published in the journal more than 100 years ago, Langenbeck's Archives of Surgery today stands out as the principal European journal in the field of endocrine surgery.

Cirugía metabólica / Metabolic surgery

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