Robo-Cob technique; transoral endoscopic coblation tongue base resection in obstructive sleep apnea patients.

Abstract

Another transoral tongue base surgical procedure for obstructive sleep apnea (OSA) is described. The procedure was named as the "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but using a coblation technology to manage tongue base hypertrophy in patients with OSA especially in countries where TORS is not an available option for such benign conditions. The technique is described step by step. The new surgical technique was carried out in 25 adult OSA patients with mean age of 41.36 ± 8.72years (average 23-56) with confirmed tongue base hypertrophy by preoperative drug-induced sleep endoscopy (DISE). Coblation was used to resect, not ablate, the tongue base with similar technique as described in TORS. The Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgery settings. There were no significant intraoperative or postoperative complications. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by polysomnography 3months postoperatively with significant decrease in mean AHI from 33.84 ± 10.54 to 11.52 ± 5.42 (P< 0.005). Moreover, this technique provided tongue base tissue specimen that allowed measurement of its volume that ranged from 10 to 22cc (mean 14.96 ± 3.62cc) to monitor extent of tissue resection. The added value of using coblation in resection, not ablation, is being quicker, and being able to provide tissue specimen to measure its volume to judge resection limits.