Journal ArticleDOI
Outcomes for multilevel surgery for sleep apnea: Obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty
Erica R. Thaler,Christopher H. Rassekh,Jonathan M. Lee,Gregory S. Weinstein,Bert W. O'Malley +4 more
TLDR
This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP).Abstract:
Objectives/Hypothesis
This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea (OSA) who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP).
Study Design
Prospective, nonrandomized trial with historical controls.
Methods
All patients underwent pre- and postoperative polysomnography, preoperative magnetic resonance imaging of the neck, preoperative drug-induced sleep endoscopy, surgery, including UPPP if this had not occurred previously, and OSA TORS. Outcomes measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), O2 saturation nadir, and total sleep time spent at <90% O2 saturation.
Results
Patients who had no prior surgery achieved an average AHI reduction from 58.4 to 19.5 (67%, P < .0001), a surgical success rate of 56%, and a surgical response rate of 73%. Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 (24%, P = .19), a surgical success rate of 30%, and a surgical response rate of 40%. Total sleep time spent at <90% O2 saturation was improved from 14% to 3.6% (P < .0003) for patients without prior surgery, and 21.1% to 12.5% (P < .17)for those with prior surgery. ESS improved for all patients combined from 12.8 to 5.8 (P < .0001).
Conclusions
Outcomes for the combined approach of OSA TORS and UPPP provide strong evidence in favor of this multilevel approach for the surgical management of OSA. The benefit of the current surgical approach is most significant for previously unoperated patients.
Level of Evidence
4. Laryngoscope, 126:266–269, 2016read more
Citations
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Journal ArticleDOI
Transoral robotic base of tongue reduction for obstructive sleep apnea: A systematic review and meta‐analysis
TL;DR: To determine the effect of transoral robotic surgery (TORS) base of tongue (BOT) reduction on sleep‐related outcomes in patients with obstructive sleep apnea (OSA), a large number of patients with OSA are treated with TORS.
Journal ArticleDOI
Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis.
Giuseppe Meccariello,Giovanni Cammaroto,Filippo Montevecchi,Paut T. Hoff,Matthew E. Spector,Hesham Negm,Medhat Shams,Chiara Bellini,Ermelinda Zeccardo,Claudio Vicini +9 more
TL;DR: TORS for the treatment of OSAHS appears to be a promising and safe procedure for selected patients seeking an alternative to continuous positive airway pressure (CPAP), although further researches are urgently needed.
Journal ArticleDOI
Transoral Robotic Surgery for Obstructive Sleep Apnea A Systematic Review and Meta-Analysis
TL;DR: The initial results for the use of TORS as part of a multilevel surgical approach for OSA are promising for select patients, however, the cost and morbidity may be greater than with other techniques offsetting its advantages in visualization and precision.
Journal ArticleDOI
Preoperative Drug Induced Sleep Endoscopy Improves the Surgical Approach to Treatment of Obstructive Sleep Apnea.
TL;DR: The addition of DISE to the preoperative workup has contributed to a decreased rate of multilevel surgery and increased rate of surgical success through identification of the individual patient’s OSA architecture and customization of the surgical plan.
Journal ArticleDOI
Tongue reduction for OSAHS: TORSs vs coblations, technologies vs techniques, apples vs oranges
Giovanni Cammaroto,Filippo Montevecchi,Giovanni D'Agostino,Ermelinda Zeccardo,Chiara Bellini,Bruno Galletti,Medhat Shams,Hesham Negm,Claudio Vicini +8 more
TL;DR: Trans-oral robotic surgery seems to give slightly better results, allowing a wider surgical view and a measurable, more consistent removal of lingual tissue, however, the higher rate of minor complication and the significant costs of TORS must also be considered.
References
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Journal ArticleDOI
The Efficacy of Surgical Modifications of the Upper Airway in Adults With Obstructive Sleep Apnea Syndrome
TL;DR: Analysis of the uvulopalatopharyngoplasty papers revealed that this procedure is, at best, effective in treating less than 50% of patients with obstructive sleep apnea syndrome, and the basis for the American Sleep Disorders Association's practice parameters on this subject is provided.
Journal ArticleDOI
Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis
Sean M. Caples,James A. Rowley,Jeffrey R. Prinsell,John F. Pallanch,Mohamed B. Elamin,Sheri G. Katz,John Harwick +6 more
TL;DR: A systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvutal surgery (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures.
Journal ArticleDOI
Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review.
TL;DR: Hypopharyngeal surgery in obstructive sleep apnea is associated with improved outcomes, although this benefit is supported largely by level 4 evidence, and future research should include larger, higher-level studies that consider the variety of treatment effects, compare surgical treatments, and identify factors associated with outcomes.
Journal ArticleDOI
Transoral Robotic Tongue Base Resection in Obstructive Sleep Apnoea-Hypopnoea Syndrome: A Preliminary Report
Claudio Vicini,Iacopo Dallan,Pietro Canzi,S Frassineti,Maria Grazia La Pietra,Filippo Montevecchi +5 more
TL;DR: Transoral robotic tongue base management in patients with OSAHS primarily related to tongue base hypertrophy is feasible and well tolerable and these preliminary results are encouraging and worthy of further evaluation.
Journal ArticleDOI
Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: anatomic considerations and clinical experience.
Claudio Vicini,Iacopo Dallan,Pietro Canzi,S Frassineti,Andrea Nacci,Veronica Seccia,Erica Panicucci,Maria Grazia La Pietra,Filippo Montevecchi,Manfred Tschabitscher +9 more
TL;DR: The purpose of this work was to describe the anatomy of the tongue base with a robotic perspective and to demonstrate the feasibility of this approach in case of tongue base hypertrophy in Obstructive Sleep Apnea‐Hypopnea Syndrome (OSAHS).