TORS as Part of Multilevel Surgery in OSA: The Importance of Careful Patient Selection and Outcomes.

Peter M Baptista,Carlos O’Connor-Reina,Natalia Diaz Zufiaurre,Lucrezia Giorgi,Antonio Moffa,Octavio Garaycochea,Guillermo Plaza,Manuele Casale,Juan Manuel Alcalde Navarrete

doi:10.3390/jcm11040990

Abstract

Transoral robotic surgery (TORS) for Obstructive Sleep Apnea (OSA) is a relatively young technique principally devised for managing apneas in the tongue base area. This study summarizes and presents our personal experience with TORS for OSA treatment, with the aim to provide information regarding its safety, efficacy, and postoperative complications. A retrospective study was conducted on patients undergoing TORS with lingual tonsillectomy through the Da Vinci robot. The effectiveness of the surgical procedure was assessed employing the Epworth Sleepiness Scale (ESS) and overnight polysomnography with the Apnea-Hypopnea Index (AHI). A total of 57 patients were included. Eighteen patients (31.6%) had undergone previous surgery. The mean time of TORS procedure was 30 min. Base of tongue (BOT) management was associated with other procedures in all patients: pharyngoplasty (94%), tonsillectomy (66%), and septoplasty (58%). At 6 months follow-up visit, there was a significant improvement in AHI values (from 38.62 ± 20.36 to 24.33 ± 19.68) and ESS values (from 14.25 ± 3.97 to 8.25 ± 3.3). The surgical success rate was achieved in 35.5% of patients. The most frequent major complication was bleeding, with the need for operative intervention in three cases (5.3%). The most common minor complications were mild dehydration and pain. TORS for OSA treatment appears to be an effective and safe procedure for adequately selected patients looking for an alternative therapy to CPAP.

Highlights

Introduction iationsObstructive Sleep Apnea (OSA) is a prevalent disorder that affects up to 24% of adult men and 9% of adult women [1]
From January 2011 to June 2021, 64 patients undergoing Transoral robotic surgery (TORS) with lingual tonsillectomy through the Da Vinci robot were included
A t-test was used to determine the difference between the Apnea-Hypopnea Index (AHI) index and Epworth Sleepiness Scale (ESS) before and after the procedure

Summary

Introduction

Obstructive Sleep Apnea (OSA) is a prevalent disorder that affects up to 24% of adult men and 9% of adult women [1]. It is considered a severe social health problem that significantly increases cardiopulmonary and cerebrovascular morbidity, daytime sleepiness, poor work performance, and traffic accidents. OSA is an independent factor for hypertension, stroke, and myocardial infarction [2]. A multilevel collapse of the upper aerodigestive tract is the leading cause of OSA in most cases, causing repetitive partial and complete airway obstructions, intermittent hypoxemia, sympathetic nervous system output surges, and sleep arousals [3]. Continuous Positive Airway Pressure (CPAP) is considered the gold standard treatment for moderate to severe OSA.

Objectives

Methods

Results

Conclusion