Research Paper
Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique
World Journal of Otorhinolaryngology-Head and Neck Surgery, 2017,03(02) : 97-100. DOI: 10.3760/cma.j.issn.2095-8811.2017.02.106
Abstract
Objective:

The present study is a review of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods:

The review presents the experience of the robotic center that developed the technique with regards to patient selection, surgical method, and post-operative care. In addition, the review provides results of a systematic review and meta-analysis of the complications and clinical outcomes of TORS when applied in the management of OSAHS.

Results:

The rate of success, defined as 50% reduction of pre-operative AHI and an overall AHI <20 events/h, is achieved in up to 76.6% of patients with a range between 53.8% and 83.3%. The safety of this approach is reasonable as the main complication (bleeding) affected 4.2% of patients (range 4.2%-5.3%). However, transient dysphagia (7.2%; range 5%-14%) does compromise the quality of life and must be discussed with patients preoperatively.

Conclusions:

TORS for the treatment of OSAHS appears to be a promising and safe procedure for patients seeking an alternative to traditional therapy. Appropriate patient selection remains an important consideration for successful implementation of this novel surgical approach requiring further research.

Cite as: Vicini Claudio, Montevecchi Filippo, Gobbi Riccardo, et al.  Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique [J]. World Journal of Otorhinolaryngology-Head and Neck Surgery,2017,03(02): 97-100. DOI: 10.3760/cma.j.issn.2095-8811.2017.02.106
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Introduction

The first transoral robotic surgery (TORS) for OSAHS was carried out in May 2008.1 It was devised as a robotically assisted transoral version of Chabolle’s operation (open transcervical Tongue Base Reduction Hyo-epiglottoplasty, TBRHE) for moderate to severe obstructive sleep apnea. In 2014, the first multicenter study about TORS in which a cohort of 243 cases from 7 groups in 5 different countries was published.2 Today, TORS is included in the surgical routine for sleep disordered breathing (SDB) treatment in a great number of ENT departments. Although cohort sizes are limited in most patient series, many groups have completed more than 50 consecutive TORS for OSAHS to date. From March 2008 until June 2016, a total of 240 TORS procedures for OSAHS were performed at our Institution. This review will summarize and present our personal experience as well as the worldwide expertise with robotic surgery for the management of OSAHS.

 
 
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Keyword
Transoral robotic surgery
Midline glossectomy
Sleep surgery
obstructive sleep apnea
Partial glossectomy
Posterior glossectomy
TORS