Transoral robotic surgery (TORS) for base of tongue neoplasms. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome. Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome Transoral Robot-Assisted Lingual Tonsillectomy and Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Outcomes for multilevel surgery for sleep apnea: Obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty.
OBJECTIVE To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation . STUDY DESIGN Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs .  Transoral robotic surgery ( TORS ) was then performed on three human patients with tongue base cancers in a prospect i ve human trial . METHODS Using the da Vinci Surgical Robot ( Intuitive Surgical , Inc. , Sunnyvale , CA ) , we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs . In the cadaver models , exposure was evaluated using three different retractors , the Dingman , Crowe Davis , and FK retractors . The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospect i ve clinical trial . The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal , hypoglossal , and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed . RESULTS The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers , dogs , and human patients . Among the three retractors evaluated , the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability . Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries . CONCLUSIONS TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients . TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery Obstructive sleep apnea syndrome is caused by narrowing of the pharyngeal airway and loss of dilator tone during sleep . In patients with severe apnea surgical correction often requires attention to both the oropharynx and hypopharynx . Tongue reduction surgery has been described for persistent apnea after failure of palatal surgery . We describe our experience with midline glossectomy with epiglottidectomy in 12 patients with a mean age of 48.8 + /- 14.2 years and body mass index of 36.0 + /- 8.8 kg/m2 . Response to treatment was defined as a postoperative respiratory disturbance index ( RDI ) below 20 . Three patients ( 25 % ) responded to treatment . The mean apnea index decreased from 48.9 to 35.7 , RDI decreased from 73.3 to 46.6 , and lowest oxygen saturation increased from 65.9 to 77.9 % . RDI in responders decreased from 69.7 to 10 . Midline glossectomy with epiglottidectomy has variable results , yet is effective in selected patients with hypopharyngeal narrowing related to macroglossia Objective Submucosal minimally invasive lingual excision ( SMILE ) is a novel approach to address hypopharyngeal obstruction . This study compares the efficacy , morbidity , and complications of this technique to radiofrequency reduction of the tongue base ( RFBOT ) , the current st and ard in minimally invasive tongue base reduction . Study Design Retrospective analysis of data extracted from a prospect i ve data base . Methods Ninety-six patients who underwent SMILE ( n = 48 ) or RFBOT ( n = 48 ) were studied .  Efficacy and safety of the procedures were compared on the basis of polysomnography results , morbidity measures , and complications . Results Patients in both groups demonstrated a significant reduction in the apnea/hypopnea index . Success rates for SMILE and RFBOT were 64.6 percent and 41.7 percent , respectively ( P = 0.024 ) . SMILE , however , was associated with increased morbidity and complications . Conclusion In a comparable surgical protocol for obstructive sleep apnea-hypopnea syndrome , SMILE technique for tongue base reduction demonstrated increased efficacy over RFBOT but result ed in more complications . Additional experience with the procedure may reduce complications and increase overall efficacy Objectives : We assessed the use of transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for the surgical management of tongue base obstruction in patients with obstructive sleep apnea . Methods : In a prospect i ve , nonr and omized trial using historical controls , patients underwent drug-induced sleep endoscopy , transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty , and preoperative and postoperative polysomnography .  Results : Twenty patients have completed the study to date . The rate of surgical success was 45 % , and the rate of surgical response was 65 % . The mean preoperative apnea-hypopnea index of 55.6 decreased by 56.7 % , to a mean postoperative value of 24.1 ( p < 0.001 ) , and the minimum arterial oxygen saturation increased from the mean preoperative value of 75.8 % to the mean postoperative value of 81.7 % ( p = 0.013 ) . The mean Epworth Sleepiness Scale score improved from 13.4 to 5.9 ( p = 0.003 ) . One patient had postoperative bleeding that required cauterization , result ing in a major complication rate of 4.2 % . Conclusions : Transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty is a novel technique for the surgical management of obstructive sleep apnea that results in a significant decrease in the apnea-hypopnea index , a significant improvement in minimum arterial oxygen saturation , and a significant improvement in the Epworth Sleepiness Scale score and has an acceptable complication rate OBJECTIVES /HYPOTHESIS This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea ( OSA ) who underwent transoral robotic surgery ( TORS ) ( i.e. , posterior glossectomy and limited lateral pharyngectomy ) with uvulopalatopharyngoplasty ( UPPP ) .  STUDY DESIGN Prospect i ve , nonr and omized trial with historical controls . METHODS All patients underwent pre- and postoperative polysomnography , preoperative magnetic resonance imaging of the neck , preoperative drug-induced sleep endoscopy , surgery , including UPPP if this had not occurred previously , and OSA TORS .  Outcomes measures included apnea-hypopnea index ( AHI ) , Epworth Sleepiness Scale ( ESS ) , O2 saturation nadir , and total sleep time spent at < 90 % O2 saturation . RESULTS Patients who had no prior surgery achieved an average AHI reduction from 58.4 to 19.5 ( 67 % , P < .0001 ) , a surgical success rate of 56 % , and a surgical response rate of 73 % . Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 ( 24 % , P = .19 ) , a surgical success rate of 30 % , and a surgical response rate of 40 % . Total sleep time spent at < 90 % O2 saturation was improved from 14 % to 3.6 % ( P < .0003 ) for patients without prior surgery , and 21.1 % to 12.5 % ( P < .17)for those with prior surgery . ESS improved for all patients combined from 12.8 to 5.8 ( P < .0001 ) . CONCLUSIONS Outcomes for the combined approach of OSA TORS and UPPP provide strong evidence in favor of this multilevel approach for the surgical management of OSA . The benefit of the current surgical approach is most significant for previously unoperated patients
Objective To perform a systematic review of the international biomedical literature evaluating the effectiveness , complications , and safety of transoral robotic surgery ( TORS ) for the treatment of obstructive sleep apnea ( OSA ) .