Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea‐hypopnea syndrome: Expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty

Vicini, Claudio; Montevecchi, Filippo; Pang, Kenny P.; Bahgat, Ahmed; Dallan, Iacopo; Frassineti, Sabrina; Campanini, Aldo

doi:10.1002/hed.23271

Cited by 84 publications

(67 citation statements)

References 12 publications

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“…In 2007, Pang et al [6] had showed an 82.6 % success rate (with 50 % reduction of pre-operative AHI and AHI \ 20) in their randomized controlled clinical trial. Vicini et al in their perspective multi-level sleep apnea surgery with palate and trans-oral robotic surgery (TORS) tongue base resection, showed that their initial post-operative data (when they used the traditional uvulopalatopharyngoplasty technique with the trans-oral tongue base resection) was only fair, with a mean postoperative AHI of 19.8 ± 14.1 compared to the expansion pharyngoplasty and the trans-oral robotic tongue base resection, which yielded a post-operative AHI of 9.9 ± 8.6; Vinci et al [16] had maintained the 2 groups controlled for BMI, gender, age, pre-operative AHI and volume of tongue base tissue removed. Carrasco et al had demonstrated in 53 patients who had moderate to severe OSA (mean pre-operative AHI 41.9 ± 24.3), that the expansion pharyngoplasty (pre-operative AHI 27.7 ± 7.5 to post-operative AHI 6.5 ± 5.2) had better results compared to the traditional uvulopalatopharyngoplasty (preoperative AHI 47.3 ± 27.1 to post-operative AHI 12.0 ± 7.1) [17].…”

Section: Discussionmentioning

confidence: 99%

Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

Pang¹,

Piccin

Pang³

et al. 2016

Indian J Otolaryngol Head Neck Surg

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To evaluate the success rates of combined Expansion Sphincter Pharyngoplasty and the Anterior Palatoplasty in the treatment of OSA. A two center prospective series of 73 patients with OSA. All patients were [18 years old, retro-palatal obstruction, concentric velo-pharyngeal collapse, BMI \ 33, Friedman clinical stage II, with all grades of AHI. The procedure involved the anterior palatoplasty, tonsillectomy and expansion sphincter pharyngoplasty with or without nasal surgery. There were 68 men and 5 women, the mean age was 46.8 years old (range of 25-67 years), mean BMI was 25.5 (range of 20.3-31.2). All patients had pre-operative and post-operative PSG. The AHI improved in all patients, mean AHI improved from 26.3 ± 17.7 to 12.6 ± 5.8 (p \ 0.001). There were 20 mild OSA, 33 moderate OSA and 20 severe OSA patients. Twenty-three patients had preoperative DISE, and 61 patients had nose/palate surgery, while only 12 had palate surgery alone. The overall success rate (50 % reduction and AHI \ 20) was 86.3 %. The mean snore scores (VAS) improved from 8.8 ± 1.2 to 2.0 ± 1.3 (p \ 0.001). The mean Epworth score improved from 11.5 ± 2.2 to 2.9 ± 2.1 (p \ 0.001). Lowest oxygen saturation also improved in all patients. Subjectively, all the patients felt less tiredness. Pre-operative DISE assessment did not seem to confer any advantage over the patients who had no pre-operative DISE (p = 0.027), and patients who had nose/palate surgery seemed to have better success rates compared to those who only had palate surgery (p = 0.081). This combined technique has been shown to be effective in selected group of OSA patients. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

Pang¹,

Piccin

Pang³

et al. 2016

Indian J Otolaryngol Head Neck Surg

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“…In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery (TORS) 1 .…”

Section: Introductionmentioning

confidence: 99%

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea

Vicini

Meccariello

Cammaroto

et al. 2017

Acta Otorhinolaryngol Ital

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Il trattamento chirurgico delle apnee ostruttive in sonno rappresenta una valida alternativa per i pazienti non complianti al ventilatore CPAP. Negli ultimi anni, lapproccio chirurgico multilivello sta divenendo pratica comune, soprattutto dallintroduzione 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.

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“…It was devised as a transoral robotic modification of Chabolle's open tongue base reduction and hyoid epiglottopexy [2]. At this time, it is estimated that more than 450 transoral robotic surgeries (TORS) for OSAHS have been performed throughout the world; 201 of them have been reported in the literature (table 1) [1,3,4,5,6,7,8]. However, there have been no multi-institutional studies examining the safety and efficacy of TORS.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes and Complications Associated with TORS for OSAHS: A Benchmark for Evaluating an Emerging Surgical Technology in a Targeted Application for Benign Disease

Vicini

Montevecchi

Campanini

et al. 2014

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Background: The aim of this study was to create benchmarks for evaluating clinical outcomes and complications of transoral robotic surgeries (TORS) in a multicenter setting. Methods: 243 TORS for obstructive sleep apnea/hypopnea syndrome (OSAHS) operations, carried out between 2008 and 2012, were analyzed at 7 different centers. The average hospitalization was 3.5 days. The mean patient age was 50 ± 12 years, the average BMI at the time of the procedure was 28.53 ± 3.87 and the majority of the patients were men (81%). Results: The mean preoperative and postoperative apnea/hypopnea index was 43.0 ± 22.6 and 17.9 ± 18.4, respectively (p < 0.001). The mean preoperative and postoperative Epworth Sleepiness Scale score was 12.34 ± 5.19 and 5.7 ± 3.49, respectively (p < 0.001). The mean pre- and postoperative lowest O₂ saturation was 79.5 ± 8.77 and 83.9 ± 6.38%, respectively (p < 0.001). Conclusions: Patients undergoing TORS as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation of success with minimal long-term morbidity.

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Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea‐hypopnea syndrome: Expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty

Abstract: As the palate component of our multilevel procedure, expansion sphincter pharyngoplasty, including conventional nose surgery and robotic surgery, seems to be superior to uvulopalatopharyngoplasty.

Cited by 84 publications

References 12 publications

Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea

Clinical Outcomes and Complications Associated with TORS for OSAHS: A Benchmark for Evaluating an Emerging Surgical Technology in a Targeted Application for Benign Disease

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