Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea

Abstract

Il trattamento chirurgico delle apnee ostruttive in sonno rappresenta una valida alternativa per i pazienti non complianti al ventilatore CPAP. Negli ultimi anni, l’approccio chirurgico multilivello sta divenendo pratica comune, soprattutto dall’introduzione della chirurgia robotica. La Barbed Reposition Pharyngoplasty nella chirurgia robotica multilivello per OSA potrebbe rappresentare una valida opzione per il trattamento del palato molle. In questo lavoro descriviamo la tecnica e risultati preliminari della nostra esperienza.

Anterolateral advancement pharyngoplasty versus barbed reposition pharyngoplasty in patients with obstructive sleep apnea

“…In a multicenter prospective study performed with 111 patients, Montevecchi et al reported that the success rate was 73% for Barbed pharyngoplasty (BP) [ 31 ]. However, promising results have been reported by Vicini et al with a success rate of 90% [ 32 ] . In 2017, Cammaroto et al showed similar results in patients with multilevel OSA at retropalatal and retrolingual airway collapse treated with palatal surgery combined with transoral robotic surgery (TORS).…”

“…Our results showed that the mean ESS significantly improved by ~ 50% in both ALA and BRP groups ( P < 0.001) with a comparable results to a study conducted by Babademez et al 2020 showing improvement by ~ 68% in both BRP and ESPwAP (expansion sphincter pharyngoplasty with anterior palatoplasty) groups [ 34 ]. In addition, a study by Montevecchi et al 2018 showed improvement by about 40% regarding BRP procedure [ 31 ], while a study by Vicini et al 2017 showed improvement by ~ 67% regarding BRP procedure [ 32 ].…”

Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty

“…The barbed suture in pharyngoplasty was demonstrated by Mantovani et al in 2013 [ 38 ] and Salamanca et al in 2014 [ 39 ], and following this, pharyngoplasty performed with barbed suture increased and became more widely recommended. Barbed reposition pharyngoplasty in multilevel surgery was noted by Vicini et al, as it could conduct a widening of the oropharyngeal lateral wall and forward sustaining of the soft palate; it was also faster, easier, and more feasible within the robotic surgery framework [ 40 ].…”

Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta‐Analysis

“…The barbed suture with knotless bidirectional resorbable material is used for obtaining a suspension of the palatopharyngeal muscle in a lateral and anterior position to the pterygomandibular raphe for expansion of the lateral walls of the oropharynx. A series of sutures enlarge the oropharyngeal isthmus laterally and rearrange anteriorly the lateral insertion of the soft palate to increase the retropalatal airway 37–40 …”

“…A series of sutures enlarge the oropharyngeal isthmus laterally and rearrange anteriorly the lateral insertion of the soft palate to increase the retropalatal airway. [37][38][39][40] Both ESP and BRP resulted in a better change in AHI and a greater surgical success rate in comparison with UPPP. 20,21,41 Many studies have shown that both procedures are cost-effective therapy as well as safe and effective in the long-term follow-up.…”