Abstract

Aim: Reporting of the personal experience of 100 cases of transoral robotic surgery (TORS) using da Vinci Si system for obstructive sleep apnoea (OSA) in terms of feasibility, result, complications and challenges.

Methodology: The review presents our 3 years of experience of TORS using the da Vinci Si systems (Intuitive surgical systems, CA, USA) at our center in moderate to severe cases of OSA. We performed base of tongue (BOT) reduction with or without partial epiglottoplasty and palatal surgery using TORS. Patient selection is critical for TORS. Failed and patients non-compliant to continuous positive airway pressure (CPAP) were recruited for surgery. Polysomnography was the key diagnostic investigation. Along with da Vinci Si robot, we used Maryland dissector (5mm), monopolar cautery with a spatula (5mm) and a 30 degrees binocular 3 dimensional scope (12mm). BOT, palate and epiglottis were addressed by robotic assistance.

Results: 8 patients underwent TORS base of tongue (BOT) reduction alone, 6 patients also had partial epiglottoplasty, 26 patients had BOT reduction with uvulopalatoplasty and 60 patients had BOT reduction with both uvulopalatoplasty along with partial epiglottoplasty. Due to poor follow up only 45 patients were reviewed for postoperative polysomnography after 4 to 6 months. Apnea-Hypopnea Index (AHI) was compared; cure (that is AHI <5) was seen in 13 out of 45 patients (28.88%) and success (that is AHI <20) was seen in 31 out of 45 patients (68.88%). Unfortunately, one patient did not show any improvement subjectively and on the basis of AHI also. None of our patient suffered from major complications.

Conclusion: Experience of TORS for tongue base reduction with or without partial epiglottoplasty and palate surgery for OSA at our tertiary center was excellent with overwhelming results showing both subjective and objective improvements with minimal complications and uneventful postoperative period.

Keywords: Transoral Robotic Surgery (TORS); Obstructive Sleep Apnoea (OSA); da Vinci Si; Base of Tongue (BOT); Epiglottoplasty; Polysomnography; Apnea-Hypopnea Index (AHI)

References

1. Justin GA., et al. “Transoral robotic surgery for obstructive sleep apnea: a systematic review and meta-analysis”. Otolaryngology - Head and Neck Surgery 154.5 (2016): 835-846.
2. Stradling JR and Crosby JH. “Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men”. Thorax 46.2 (1991): 85-90.
3. Toh ST., et al. “Transoral robotic surgery for obstructive sleep apnea in Asian patients: a Singapore sleep centre experience”. JAMA Otolaryngology–Head and Neck Surgery 140.7 (2014): 624-629.
4. Miller SC., et al. “Transoral robotic base of tongue reduction for obstructive sleep apnea: A systematic review and meta‐analysis”. The Laryngoscope 127.1 (2017): 258-265.
5. Caples SM., et al. “Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis”. Sleep 33.10 (2010): 1396-1407.
6. Lin HS., et al. “Transoral robotic surgery for treatment of obstructive sleep apnea‐hypopnea syndrome”. The Laryngoscope 123.7 (2013): 1811-1816.
7. Vicini C., et al. “Transoral robotic surgery of the tongue base in obstructive sleep apnea‐hypopnea syndrome: anatomic considerations and clinical experience”. Head and Neck 34.1 (2012): 15-22.
8. Lee JM., et al. “Transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for obstructive sleep apnea”. Annals of Otology, Rhinology and Laryngology 121.10 (2012): 635-639.
9. Hoff PT., et al. “Transoral robotic surgery in benign diseases including obstructive sleep apnea: safety and feasibility”. The Laryngoscope 125.5 (2015): 1249-1253.
10. Friedman M., et al. “Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome”. Otolaryngology--Head and Neck Surgery 146.5 (2012): 854-862.
11. O'Malley Jr BW., et al. “Transoral robotic surgery (TORS) for base of tongue neoplasms”. The Laryngoscope 116.8 (2006): 1465-1472.
12. Vicini C., et al. “Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report”. Otorhinolaryngology 72.1 (2010): 22-27.
13. Lauretano AM., et al. “Anatomic location of the tongue base neurovascular bundle”. The Laryngoscope 107.8 (1997): 1057-1059.
14. Sayin I., et al. “Transoral robotic tongue base reduction in surgical management of obstructive sleep apnea syndrome”. B-ENT (2015): 51-54.
15. Meccariello G., et al. “Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis”. European Archives of Oto-Rhino-Laryngology 274.2 (2017): 647-653.
16. Vicini C., et al. “Clinical outcomes and complications associated with TORS for OSAHS: a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease”. Otorhinolaryngology 76.2 (2014): 63-69.
17. Paker M., et al. “Long‐term swallowing performance following transoral robotic surgery for obstructive sleep apnea”. The Laryngoscope 129.2 (2019): 422-428.
18. Parmar A., et al. “Robotic surgery in ear nose and throat”. European Archives of Oto-Rhino-Laryngology 267.4 (2010): 625-633.
19. Oliveira CM., et al. “Robotic surgery in otolaryngology and head and neck surgery: a review”. Minimally Invasive Surgery (2012): 286563.
20. Aurora RN., et al. “Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults”. Sleep 33.10 (2010): 1408-1413.
21. Caples SM., et al. “Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis”. Sleep 33.10 (2010): 1396-1407.
22. Sundaram S., et al. “Surgery for obstructive sleep apnoea in adults”. Cochrane Database of Systematic Reviews 4 (2005).
23. Hoff PT., et al. “Body mass index predicts success in patients undergoing transoral robotic surgery for obstructive sleep apnea”. Otorhinolaryngology 76.5 (2014): 266-272.

Citation

Citation: Kalpana Nagpal., et al. “Transoral Robotic Surgery for Obstructive Sleep Apnea: Experience of 100 Cases in Our Tertiary Care Hospital". Acta Scientific Otolaryngology 2.4 (2020): 02-06.

Copyright

Copyright: © 2020 Kalpana Nagpal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.