Robotic Glossectomy for the Treatment of Obstructive Sleep Apnea/Hypopnea Syndrome

Abstract

Objective: 1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base-of-tongue (RFBOT) MG. Method: Retrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications. Results: Twenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for ( P < .05). Twenty patients with moderate disease treated with palatal stiffening + RG were compared with 20 patients with RFBOT + palatal stiffening. Pain outcomes measured on postoperative days 0-5 using the Faces Visual Analogue Scale (VAS) resulted in no statistical difference between RG and coblation whereas RG vs RFBOT showed higher pain levels for RG. Conclusion: This is the first recorded series of robotic MG performed without the need for tracheotomy. Results demonstrated an excellent safety profile with no significant complications. Although morbidity vs standard hypopharyngeal treatments is significant, robotic glossectomy allows for more aggressive tissue removal vs coblation and RFBOT thereby significantly improving efficacy.