1
|
Lechien JR, Chiesa-Estomba CM, Fakhry N, Saussez S, Badr I, Ayad T, Chekkoury-Idrissi Y, Melkane AE, Bahgat A, Crevier-Buchman L, Blumen M, Cammaroto G, Vicini C, Hans S. Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis. Head Neck 2021; 43:2216-2239. [PMID: 33860981 DOI: 10.1002/hed.26702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 02/04/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022] Open
Abstract
We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea-Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69-26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50-9.34). The summary estimate of increase in lowest O2 saturation was 6.04% (95% CI: 3.05-9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64-79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O2 saturation.
Collapse
Affiliation(s)
- Jerome R Lechien
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos-Miguel Chiesa-Estomba
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Nicolas Fakhry
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Ibrahim Badr
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford School of Medicine, Stanford, USA
| | - Tareck Ayad
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Younes Chekkoury-Idrissi
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Antoine E Melkane
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ahmed Bahgat
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology, Faculty of Medicine, Alexandria Hospital, Alexandria, Egypt
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Marc Blumen
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Giovanni Cammaroto
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Claudio Vicini
- Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Stéphane Hans
- Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| |
Collapse
|
2
|
Zhao C, Viana A, Ma Y, Capasso R. Insights into Friedman stage II and III OSA patients through drug-induced sleep endoscopy. J Thorac Dis 2020; 12:3663-3672. [PMID: 32802445 PMCID: PMC7399404 DOI: 10.21037/jtd-20-1471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The Friedman staging is a classic system to predict outcomes of obstructive sleep apnea (OSA) surgery. Increasing stage indicates more severe upper airway (UA) obstruction and worse surgical successful rate. In previous studies, the UA obstruction between stages were usually assessed based on awake examination. Drug-induced sleep endoscopy (DISE) is a new method that can evaluate airway collapse characteristics during sleep. Therefore, we planned to compare Friedman staging and DISE findings and fulfill the knowledge gap on the correlation between awake and sedated UA examination. Methods Retrospective case series study that assessed patients with OSA who underwent DISE. Subjects were classified to stage II and stage III groups based on Friedman staging system. UA collapse characteristics based on velum, oropharynx, tongue base, epiglottis (VOTE) classification, including single/multiple obstruction sites, single/combined upper and lower obstruction levels, collapse degree and patterns in different sites, and surgical results among the groups were analyzed. Results A total of 175 cases were analyzed. No significant differences were found in baseline measurements between groups. Stage III patients (n=102) had a higher proportion (74.5%) with 3 or 4 obstruction sites than stage II (57.5%, n=73). Velum (V) + oropharynx (O) + tongue base (T) was the most common multi-sites combined obstruction pattern with 33% in stage II and 37% in stage III, isolated lower level obstruction was the least with 6% and 4%, respectively. No significant differences were found in obstruction sites and levels. 106 patients underwent surgeries and 33 had post-surgical sleep study, 73.7% and 63.6% response rate were found in stage II and III with no significant difference. Conclusions Upper and lower combined obstruction was the main pattern of collapse in both, Friedman stage II and III patients. Patients with OSA and Friedman stage III had more than 2 sites of obstruction than stage II patients.
Collapse
Affiliation(s)
- Chen Zhao
- Department of Otorhinolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China.,Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Alonço Viana
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA.,Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Brazil.,Department of Otorhinolaryngology, Marcílio Dias Naval Hospital, Brazil
| | - Yifei Ma
- Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA
| |
Collapse
|
3
|
Merna C, Lin HW, Bhattacharyya N. Clinical Characteristics, Complications, and Reasons for Readmission following Lingual Tonsillectomy. Otolaryngol Head Neck Surg 2019; 160:619-621. [DOI: 10.1177/0194599819827820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This brief communication regards the indications and complications for and rates of readmission following lingual tonsillectomy. The National Readmissions Database (NRD) 2013-2014 was queried for all cases of lingual tonsillectomy occurring from 2013 to 2014. Among 602 lingual tonsillectomies (mean age 36.5 years, 58.2% male), the common indications for surgery were obstructive sleep apnea (58.7%), lingual tonsil hypertrophy/infection (18.8%), and neoplasia (15.9%). Overall, 49 (8.2%) of the cases were readmitted (95% confidence interval, 4.8%-13.5%), with an average readmission duration of 3.0 days and average readmission cost of $25.4K. The most common diagnoses at readmission were bleeding (1.9% of all lingual tonsillectomy cases); dysphagia (1.7%); fever, nausea, vomiting, or diarrhea (1.6%); acute pain (1.6%); and airway obstruction (1.4%). There were no mortalities during primary or subsequent admissions. Lingual tonsillectomy across age groups is relatively free of adverse events, with overall readmission and complication rates similar to those of palatine tonsillectomy.
Collapse
Affiliation(s)
- Catherine Merna
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California at Irvine, Orange, California, USA
| | - Harrison W. Lin
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California at Irvine, Orange, California, USA
| | - Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Garas G, Kythreotou A, Georgalas C, Arora A, Kotecha B, Holsinger FC, Grant DG, Tolley N. Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s)? Ann Med Surg (Lond) 2017. [PMID: 28649379 PMCID: PMC5470525 DOI: 10.1016/j.amsu.2017.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS) is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA) in obese patients following failure of conventional treatment(s). A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances). TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm-2) exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s). There is a paucity of evidence on the subject with complete absence of RCTs. The literature supports TORS as a safe multilevel treatment for OSA. The effectiveness of TORS for OSA drops with increasing BMI. TORS represents an important treatment for OSA in non-morbidly obese patients after failure of conventional treatment(s). There is no role for TORS as an OSA treatment in morbidly obese patients.
Collapse
Affiliation(s)
- George Garas
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Anthousa Kythreotou
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christos Georgalas
- Department of Otorhinolaryngology and Head & Neck Surgery, Hygeia Hospital, Athens, Greece
| | - Asit Arora
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Bhik Kotecha
- Department of Otorhinolaryngology and Head & Neck Surgery, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK
| | - Floyd C Holsinger
- Department of Otorhinolaryngology and Head & Neck Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - David G Grant
- Department of Otorhinolaryngology and Head & Neck Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Neil Tolley
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
5
|
Meraj TS, Muenz DG, Glazer TA, Harvey RS, Spector ME, Hoff PT. Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea? Laryngoscope 2016; 127:971-976. [PMID: 27796047 DOI: 10.1002/lary.26255] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/06/2016] [Accepted: 07/25/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to determine if drug-induced sleep endoscopy (DISE) was predictive of success for patients undergoing transoral robotic surgery (TORS) and multilevel procedures for sleep apnea. STUDY DESIGN Retrospective case series of patients who underwent TORS surgery for sleep apnea METHODS: Before and after polysomnograms were analyzed to assess improvement, success, and cure. Improvement was defined as any decrease in apnea-hypopnea index (AHI), success as an AHI <20 with a decrease >50%, and cure as an AHI <5. DISE videos were scored using the NOHL (nose, oropharynx, hypopharynx, larynx) and VOTE (velum, oropharynx, tongue, epiglottis) classification systems. RESULTS One hundred one patients were available for analysis. Eighty-seven percent of patients had an improvement in their AHI. Fifty-one percent met criteria for success, whereas 17% were cured. The degree of collapse at individual NOHL and VOTE subsites as well as total additive scores did not predict improvement, success, or cure. Patients with no oropharyngeal lateral collapse in the VOTE classification system were more likely to improve following surgery (P = .001); however, this effect did not hold for success or cure. Multivariate analysis of DISE variables was not predictive of success. CONCLUSIONS In obstructive sleep apnea patients, there is a 51% success rate and a 17% cure rate. DISE, as scored by the NOHL and VOTE system, did not readily identify patients who would benefit most from surgery. Patients with lateral oropharyngeal collapse may be poorer candidates. Prospective, larger studies are required to further evaluate the use of DISE in predicting success following TORS. LEVEL OF EVIDENCE 4 Laryngoscope, 127:971-976, 2017.
Collapse
Affiliation(s)
- Taha S Meraj
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Daniel G Muenz
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Tiffany A Glazer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Rebecca S Harvey
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Paul T Hoff
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| |
Collapse
|
6
|
Miller SC, Nguyen SA, Ong AA, Gillespie MB. Transoral robotic base of tongue reduction for obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016; 127:258-265. [DOI: 10.1002/lary.26060] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen C. Miller
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Shaun A. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Adrian A. Ong
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - M. Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|