The objective of this study is to compare the efficacy and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas. A total of 105 follow-up cases including 60 in endoscopic surgery and 45 in microscopic surgery were treated in our hospital between January 2012 and November 2014. The endoscopic approach had a higher rate of gross tumor removal (81.7% versus 62.2%, P < 0.05) as well as a lower rate of postoperative complications (18.3% versus 35.6%, P < 0.05) than that in the microscopic group. There was no significant difference in the rates of visual improvement and cerebrospinal fluid leak between endoscopic group and microscopic group (P > 0.05). The length of the operation was longer (175 ± 25 minutes versus 110 ± 17 minutes, P < 0.05) but the postoperative hospital stay was significantly shorter (5.1 ± 0.7 versus 7.8 ± 0.8 days, P < 0.05) for the endoscopic surgery group compared with microscopic surgery group. Endoscopic approach provides a wide surgical field and broad lateral vision making easier distinction of tumor tissue. The results of this study support the safety and short-term efficacy of endoscopic pituitary surgery.