The main aims of treatment of acromegaly are reversing symptoms and signs, removing the tumour, preventing disease recurrence, and improving survival. Increased mortality associated with acromegaly can be diminished if treatment is successful in reducing GH <22.5 ng/ml. We carried out a prospective study to assess whether recent advances in surgical technique (namely the endoscopic approach in a specialised centre encompassing specialist pituitary surgeons working in team with endocrinologists, pathologists, and neuroradiologists) could obtain remission and stable disease control in the majority of acromegalic patients. Between 1998 and 2007, 152 consecutive acromegalic patients (65 men; 48 microadenomas; median age, 46 years, range 1378) underwent pituitary surgery. Of these, 26 (17%) were operated for a residual tumour, while the remainder (83%) had had no previous intervention for their pituitary adenoma. On the basis of tumour extension, the pituitary adenomas were classified into grade 0 (18.4%), grade I (9.6%), grade II (57.5%), grade III (13.2%), and grade IV (1.3%). Surgery led to partial hypopituitarism in 2.6% and permanent diabetes insipidus in 1.3%. Based on biochemical criteria evaluated 36 months after surgery (mean GH <2.5 ng/ml, nadir GH on 75-g OGTT <1 ng/ml, and IGF-I in the normal age- and sex-related range), the overall remission rate was 68%, despite the lack of a residual tumour on MRI in 76%. A partial surgical success was achieved in 21% of cases (clinically relevant improvement with or without a residual tumour). The remainder 11% showed an active disease with a residual tumour on MRI. Our prospective study has showed that recent technical advances in surgical approach to the sella coupled with expertise surgeons working in team can obtain remission of the disease in about two thirds of cases, even though 17% of patients in our series had had a previous intervention.