Adding to the evidence base for endoscopic stapes surgery, this systematic review and analysis of outcomes sought to establish the efficacy and safety of this approach. This review included 14 studies with a pooled sample of 314 adult patients. The authors performed pooled analysis of postoperative audiological and complication data. Postoperative air-bone gap closure to within 20dB hearing loss was achieved in 95.3% of a pooled population of 300 individuals. An air-bone gap closure to within 10dBHL was achieved in 76.6% of a smaller pooled population of 197 individuals. Complication rates were comparable to microscopic stapes surgery: three patients (0.9%) experienced a temporary facial nerve palsy with complete recovery; two patients (0.6%) experienced moderate sensorineural hearing losses; perilymph fistula was noted on four occasions (1.3%); 13 patients (5%) experienced postoperative taste disturbance. This study further supports total endoscopic stapes surgery as a safe and efficacious alternative to conventional microscopic otology. Endoscopic ear surgery remains a rapidly evolving field and further advances in endoscopic equipment, such as 3D systems, will continue to fuel extended applications of the otoendoscope. Reviews, such as this, that demonstrate parity in efficacy and safety are essential in establishing endoscopic ear surgery as an alternative to conventional techniques.