Objective To investigate the clinical effect of endoscopic transsphenoidal approach versus microscopic approach in pituitary adenoma resection.Methods A total of 71 patients with pituitary adenomas who were treated in our hospital from August 2016 to April 2018 were enrolled, among whom 40 underwent pituitary adenoma resection via the endoscopic transsphenoidal approach and 31 underwent pituitary adenoma resection via the microscopic approach. The tumor resection rate was evaluated based on imaging and endocrinological examinations, and the changes in hormone level, visual field recovery, and complications were observed after surgery.Results Of all patients in the endoscopic group, 38 (95%) had total resection and 2 (5%) had subtotal resection, while of all patients in the microscopic group, 23 (74.19%) had total resection and 8 (25.81%) had subtotal resection; the endoscopic group had a significantly higher total resection rate than the microscopic group (P<0.05). The endoscopic group had significantly lower levels of prolactin and adrenocorticotropic hormone after surgery than the microscopic group (P<0.05), and there was no significant difference between the two groups in the level of growth hormone after surgery (P>0.05). At 1 week after surgery, both groups had an increase in weighted visual field index and reductions in mean deviation and pattern standard deviation of visual field, and the endoscopic group had significantly greater improvements than the microscopic group (P<0.05). The endoscopic group had a significantly lower incidence rate of postoperative complications than the microscopic group (P<0.05).Conclusions Compared with the conventional microscopic approach for pituitary adenoma resection, endoscopic transsphenoidal approach can achieve a higher total resection rate and has advantages in improving hormone levels and visual improvement, with a low incidence rate of postoperative complications and high safety. Therefore, it holds promise for clinical application as a main surgical approach.