Kalpana Nagpal1*, Noor Ul Din Malik1, Nishant Rana1 and Chitra Chatterji2
1Department of ENT and Head and Neck surgery, Indraprastha Apollo Hospitals, India
2Department of Anesthesiology, Indraprastha Apollo Hospitals, India
*Corresponding Author: Kalpana Nagpal, Department of ENT and Head and Neck surgery, Indraprastha Apollo Hospitals, India.
Received: February 13, 2020; Published: March 11, 2020
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)
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: © 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.