Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique

Abstract

ObjectiveThe present study is a review of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).MethodsThe review presents the experience of the robotic center that developed the technique with regards to patient selection, surgical method, and post-operative care. In addition, the review provides results of a systematic review and meta-analysis of the complications and clinical outcomes of TORS when applied in the management of OSAHS.ResultsThe rate of success, defined as 50% reduction of pre-operative AHI and an overall AHI <20 events/h, is achieved in up to 76.6% of patients with a range between 53.8% and 83.3%. The safety of this approach is reasonable as the main complication (bleeding) affected 4.2% of patients (range 4.2%–5.3%). However, transient dysphagia (7.2%; range 5%–14%) does compromise the quality of life and must be discussed with patients preoperatively.ConclusionsTORS for the treatment of OSAHS appears to be a promising and safe procedure for patients seeking an alternative to traditional therapy. Appropriate patient selection remains an important consideration for successful implementation of this novel surgical approach requiring further research.

Obstructive Sleep Apnea Surgical Options: A Phenotypical Approach

“…30,31 On the other hand, procedures for tongue base reduction have demonstrated favorable results, 32 where one of surgical techniques that presented best outcomes was described by Vicini et al using the transoral robotic surgery. 33 It is performed using the Da Vinci® surgical system, which consists in a surgeon console, a patient cart and a control tower. The patient cart offers up to 4 robotic arms, but only three are used in this surgery: one connected to a 3D high-definition camera that provides an image with up to 10x zoom throughout 8 mm diameter endoscope (0º or 30º) and other two attached to 270º movement instruments (Endo Wrist®), a Maryland bipolar grasping and a Monopolar spatula, positioned on each side of the camera.…”

Prospective randomized comparison of tongue base resection techniques: Robotic vs coblation

“…The technique of transoral robotic surgery (TORS) was originally described in 2008 by Vicini . Tongue base radiofrequency (coblator) was used in 2005 as a therapeutic tool for OSA by He et al In previous reports, the rate of success, defined as 50% reduction of preoperative AHI and overall AHI 20 events/h, is achieved in up to 76% of patients with a range of 53%‐83% for TORS and similar rates for Coblation …”

“…1 Tongue base radiofrequency (coblator) was used in 2005 as a therapeutic tool for OSA by He et al 2 In previous reports, the rate of success, defined as 50% reduction of preoperative AHI and overall AHI 20 events/h, is achieved in up to 76% of patients with a range of 53%-83% for TORS and similar rates for Coblation. 3,4 Determining the anatomical and physiological site of obstruction is crucial for matching a patient to the appropriate surgical intervention. Multilevel obstructions are commonly identified in up to 54% of patients.…”

Lingual tonsil lymphatic tissue regrowth in patients undergoing transoral robotic surgery

“…Nowadays, with the advent of transoral robotic surgery (TORS), the removal of this exuberant LT appears easier, and the number of procedures for lingual tonsillectomy have markedly increased . TORS was initially introduced as a surgical technique for the treatment of head and neck cancers .…”

“…Robotic surgery allows blunt dissection of the excessive LT from the muscular plane of the BOT to achieve a complete resection of LT . However, the lingual tonsil LT does not present a capsule dividing it from the underlying tissues, as the palatine tonsils do; therefore, lymphatic cell aggregates may remain after the procedure, especially in the lateral region of the BOT …”