Comparison of robotic and coblation tongue base resection for obstructive sleep apnoea.

Abstract

To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection. Retrospective case-control study. University-based tertiary care medical center. Patients with obstructive sleep apnoea (OSA) who underwent endoscope-guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate-to-severe OSA with tongue base collapse and a minimum follow-up period of 6months with postoperative polysomnography (PSG) were enrolled in this study. All patients underwent pre- and postoperative (at least 4months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared. Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P<.0001) in the TORS group and from 45.6 to 16.2 events/h (P<.0001) in the coblation group. The mean rates of improvement (AHI reduction>50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients. Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.