The opening through which transsphenoidal surgery is performed is very small, about an inch. Therefore, it is not possible to look with unaided vision at the surgical area or tumor. However, modern technology has developed tools for visualizing the area of the tumor through the small hole. This is done by using a high powered operating microscope, or a fiberoptic endoscope. The operating microscope allows binocular vision with extremely high quality optics. This is very important for tiny tumors, like those responsible for Cushings disease. The endoscope provides a wider field of view, but usually with monocular images as seen on a television screen. At the Massachusetts General Hospital, a direct transnasal approach is used, whether we use the microscope or the endoscope, or both. With the direct transnasal approach, the need for postoperative nasal packing (bandaging in the nose) is minimized, regardless of whether the microscope or endoscope is used.