Transoral robotic surgery for treatment of obstructive sleep apnea-hypopnea syndrome

Abstract

Objectives/hypothesis: To evaluate the efficacy of base of tongue (BOT) resection via transoral robotic surgery (TORS) in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS).

Study design: Case series

Methods: Between June 2010 and May 2012, BOT resection via TORS was performed on 27 patients with OSAHS. Patients were excluded from this analysis if other concomitant upper airway procedures such as uvulopalatopharyngoplasty were performed, or if postoperative polysomnograms were not available.

Results: Twelve patients who underwent BOT resection alone were included in this study. The median age for these 12 patients was 48.5 (range, 19-64) and included nine females and three males. The mean apnea-hypopnea index (AHI) was 43.9 ± 41.1 preoperatively and 17.6 ± 16.2 postoperatively. This difference in AHI was statistically significant (P = 0.007) and reflected an average AHI reduction of 56.2 ± 28.3%. Statistical significant reductions in daytime somnolence level, as measured by Epworth Sleepiness Scale (13.7 ± 5.2 preoperatively vs. 6.4 ± 4.5 postoperatively, P <0.001), and snoring intensity, as reported by a bed partner using a Visual Analogue Scale (8.6 ± 1.2 preoperatively vs. 4.2 ± 1.9 postoperatively, P <0.001), were achieved. There was no statistical significant difference between the preoperative and postoperative body mass index (34.5 ± 7.3 vs. 33.5 ± 6.7, P = 0.296) or minimum oxygen saturation (83.3 ± 5.5% vs. 84.0 ± 6.4%, P = 0.680).

Conclusions: This is the first study looking at the use of TORS to address obstruction at the level of BOT only, not confounded by surgical alterations at other levels of upper airway. This preliminary result on the use of BOT resection via TORS for the treatment of patients with OSAHS is encouraging and warrants further investigations.