Background: Pituitary adenoma (PA) is a common intracranial tumor and surgical treatment is considered to be the best treatment for most patients. The extended endoscopic endonasal approach (EEEA) has been used to treat increasing numbers of patients with PA in recent years. We conducted this study to evaluate the safety and efficacy of this approach for PA resection. Methods: We performed a retrospective analysis of all patients who underwent an EEEA to remove PA by a binostril, four-handed technique between October 2013 and April 2016 in our department. The medical information of the patients including gender, age, tumor size, hormone level, clinical outcome, and complications were collected and analyzed.Results: From a total of 593 pituitary adenoma surgeries, 171 patients (101 male and 70 female, mean age 47.4 ± 12.8 years) underwent EEEA, including 96 with functional adenomas (56.14%) and 75 with nonfunctional adenomas (43.86%). The most common symptoms were headache and vision change. Gross total resection was achieved in 126 patients (73.68%). Common complications were hyposmia or anosmia, diabetes insipidus, hypopituitarism, postoperative cerebrospinal fluid leak, cerebral hemorrhage, and epistaxis. The mean duration of follow-up was 14.6 months (range: 6–31 months). Conclusions: The application of EEEA for PA resection by a binostril, four-handed technique provided great surgical freedom with minimal invasion, and resulted in few complications. EEEA is a secure and effective surgical method that could be used for the majority of PAs.