Da Vinci System for Treatment of Sleep Apnea Syndrome

Abstract

Objective: Tongue base hypertrophy is frequently related with sleep apnea-hypopnea syndrome (OSAHS). The objectives were: 1) To determine which patients are candidates for tongue base resection by means of trans ral robotic Surgery (TORS). 2) To evaluate the clinical results of this technique associated or not with other treatments. Method: All patients were diagnosed with OSAHS with obstructing tongue base through polysomnography, office endoscopy, and drug-induced sleep endoscopy (DISE). Ten patients with OSAHS and obstructive tongue base were surgically treated with TORS using the Intuitive da Vinci system and traditional surgical techniques for OSAHS between August and December 2011. Results: The mean preoperative apnea-hyponea index (IAH) was 40.67 (22.26-78.21). Patients did not require tracheotomy, and no major complications were observed during or after surgery. Tongue base and epiglottis were managed securely, and no problems with hemostasis were observed. Swallowing pain was present a mean of 10 days after surgery with satisfactory response to therapy with corticoesteroids and nonsteroidal anti-inflammatory drugs. One of the patients presented an epidermoid tumor in the right side of the tongue base causing the obstructive syndrome; it was resected with no affected margins using the TORS technique. Conclusion: The DISE technique is a useful test to determinate which patients are candidates for tongue base surgery. All patients archived a significant improvement of their IAH and Epworth Sleepiness Scale (ESS). The Intuitive da Vinci system provides excellent visualization and tissue management with low morbidity.