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Hsu HJ, Wu JL, Hsiao JR, Lin CY. Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction. Laryngoscope 2021; 132:1125-1131. [PMID: 34713890 DOI: 10.1002/lary.29931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral robotic surgery (TORS) in the base of the tongue (BOT) reduction has been shown to decrease the apnea-hypopnea index (AHI) and improve daytime sleepiness in obstructive sleep apnea (OSA) patients. Intraoperative ultrasound (IOU) can be employed to guide the surgery and prevent massive bleeding. STUDY DESIGN Cohort study with historical control. METHODS A cohort study to compare the outcomes between OSA patients who received TORS with and without IOU assistance. RESULTS From 2016 to 2019, this study enrolled 80 OSA patients who underwent TORS in BOT: 57 in the IOU(+) and 23 in IOU(-) groups. The TORS with IOU presented with shorter operative time, less blood loss, and greater excised BOT volume. The IOU(+) group had greater improvement in the AHI and subjective questionnaire evaluation. The excised volume of BOT was significantly associated with the change in AHI. CONCLUSION The IOU could improve outcomes in BOT reduction surgery without raising the risk of surgical complications. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Karaman M, Gün T, Temelkuran B, Aynacı E, Kaya C, Tekin AM. Comparison of fiber delivered CO 2 laser and electrocautery in transoral robot assisted tongue base surgery. Eur Arch Otorhinolaryngol 2017; 274:2273-2279. [PMID: 28190091 DOI: 10.1007/s00405-017-4449-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Abstract
To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.
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Affiliation(s)
- Murat Karaman
- Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey.
| | - Taylan Gün
- Department of otorhinolaryngology, Bahçeşehir University, Istanbul, Turkey
| | - Burak Temelkuran
- OmniGuide Surgical, London, UK
- OmniGuide Surgical, Lexington, MA, USA
| | - Engin Aynacı
- Department of pulmonology, Istanbul Medipol University, Istanbul, Turkey
| | - Cem Kaya
- Department of anesthesiology, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Mahmut Tekin
- Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey
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Montevecchi F, Cammaroto G, Meccariello G, D'Agostino G, Hsu YS, Galletti B, Vicini C. Trans-oral robotic surgery (TORS) for the treatment of lingual tonsillitis. When conventional therapies fail. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/02/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
| | | | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
| | - Giovanni D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
| | - Ying-Shuo Hsu
- Department of Otolaryngology, Head and Neck surgery; Shin-Kong Wu-Ho-Su hospital; Taipei Taiwan
| | - Bruno Galletti
- Department of Otolaryngology; University of Messina; Messina Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit; Morgagni Pierantoni Hospital; Forlì Italy
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Tongue reduction for OSAHS: TORSs vs coblations, technologies vs techniques, apples vs oranges. Eur Arch Otorhinolaryngol 2016; 274:637-645. [DOI: 10.1007/s00405-016-4112-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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Meccariello G, Cammaroto G, Montevecchi F, Hoff PT, Spector ME, Negm H, Shams M, Bellini C, Zeccardo E, Vicini C. Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2016; 274:647-653. [PMID: 27221389 DOI: 10.1007/s00405-016-4113-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious social health problem with significant implications on quality of life. Surgery for OSAHS has been criticized due to a lack of evidence to support its efficacy as well as the heterogeneous reporting of published outcomes. Moreover, the transoral robotic surgery (TORS) in the management of OSAHS is still in a relative infancy. Nevertheless, a review and meta-analysis of the published articles may be helpful. Among 195 articles, eight studies were included in the analysis. The mean of enrolled patients was 102.5 ± 107.9 (range 6-289) comprising a total of 820 cases. The mean age was 49 ± 3.27 and 285 patients underwent a previous sleep apnea surgery. The uvulopalatopharyngoplasty (UPPP) was the most common palatal procedure. The mean rate of failure was 34.4 % (29.5-46.2 %). Complications occurred in 21.3 % of the patients included in the analysis, most of them were classified as minor. Transient dysphagia represented the most common complication (7.2 %) followed by bleeding (4.2 %). TORS for the treatment of OSAHS appears to be a promising and safe procedure for selected patients seeking an alternative to continuous positive airway pressure (CPAP), although further researches are urgently needed.
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Affiliation(s)
- Giuseppe Meccariello
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy.
| | - Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Messina, Italy
| | - Filippo Montevecchi
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
| | - Paut T Hoff
- Department of Otolaryngology-Head and Neck Surgery, St Joseph Mercy Health System, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Hesham Negm
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Medhat Shams
- Department of Otolaryngology Head and Neck Surgery, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Chiara Bellini
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
| | - Ermelinda Zeccardo
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
| | - Claudio Vicini
- Otolaryngology and Stomatology Unit, Department of Head-Neck Surgeries, G.B. Morgagni-L.Pierantoni Hospital, Azienda USL della Romagna, via Carlo Forlanini, 34, Forlì, Italy
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TORS for Obstructive Sleep Apnea–Hypopnea Syndrome. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Eesa M, Montevecchi F, Hendawy E, D’Agostino G, Meccariello G, Vicini C. Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation. Eur Arch Otorhinolaryngol 2015; 272:1537-41. [DOI: 10.1007/s00405-014-3480-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022]
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Vicini C, Montevecchi F, Campanini A, Dallan I, Hoff PT, Spector ME, Thaler E, Ahn J, Baptista P, Remacle M, Lawson G, Benazzo M, Canzi P. Clinical outcomes and complications associated with TORS for OSAHS: a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. ORL J Otorhinolaryngol Relat Spec 2014; 76:63-9. [PMID: 24777053 DOI: 10.1159/000360768] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/18/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this study was to create benchmarks for evaluating clinical outcomes and complications of transoral robotic surgeries (TORS) in a multicenter setting. METHODS 243 TORS for obstructive sleep apnea/hypopnea syndrome (OSAHS) operations, carried out between 2008 and 2012, were analyzed at 7 different centers. The average hospitalization was 3.5 days. The mean patient age was 50 ± 12 years, the average BMI at the time of the procedure was 28.53 ± 3.87 and the majority of the patients were men (81%). RESULTS The mean preoperative and postoperative apnea/hypopnea index was 43.0 ± 22.6 and 17.9 ± 18.4, respectively (p < 0.001). The mean preoperative and postoperative Epworth Sleepiness Scale score was 12.34 ± 5.19 and 5.7 ± 3.49, respectively (p < 0.001). The mean pre- and postoperative lowest O2 saturation was 79.5 ± 8.77 and 83.9 ± 6.38%, respectively (p < 0.001). CONCLUSIONS Patients undergoing TORS as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation of success with minimal long-term morbidity.
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