Clinical Outcomes and Complications Associated with TORS for OSAHS: A Benchmark for Evaluating an Emerging Surgical Technology in a Targeted Application for Benign Disease

Vicini, Claudio; Montevecchi, Filippo; Campanini, Aldo; Dallan, Iacopo; Hoff, Paul T.; Spector, Matthew E.; Thaler, Erica R.; Ahn, Jeffrey; Baptista, Peter; Remacle, Marc; Lawson, George; Benazzo, Marco; Canzi, Pietro

doi:10.1159/000360768

Cited by 89 publications

(131 citation statements)

References 16 publications

(11 reference statements)

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“…With improved visualization and the ability to quantify the amount of tissue resected in real time, it appears that TORS-assisted lingual tonsillectomy offers some clear advantages to previous procedures. A large multicenter trial has shown the efficacy of TORS as part of a multilevel approach to obstructive sleep apnea is effective with an overall success rate of 67% [19]. …”

Section: Discussionmentioning

confidence: 99%

Addressing the Retrolingual Space in Obstructive Sleep Apnea: Outcomes Stratified by Friedman Stage in Patients Undergoing Transoral Robotic Surgery

Spector

Glazer

Hoff³

2015

ORL

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Background/Aims: To stratify outcomes in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) undergoing transoral robotic surgery (TORS) ± multilevel procedures according to Friedman stage. Methods: A total of 118 patients with moderate to severe OSAHS between 2010 and 2013 were stratified preoperatively by Friedman stage. All patients had TORS-assisted lingual tonsillectomy, either stand-alone or in combination with palatal surgery. Apnea-hypopnea index (AHI) was measured preoperatively and 3 months postoperatively. Success was defined as a decrease in AHI by 50% and AHI <20. Results: The average pre- and postoperative AHI was 43.0 and 22.6, respectively, and the overall success rate was 63%. When stratifying by Friedman stage, success was seen in 75% of stage I, 70% of stage II, 66% of stage III, and 10% of stage IV patients. When stratifying by preoperative BMI, success was seen in 75% of stage II and 72% of stage III patients with BMI <30, compared to 58% of stage II and 56% of stage III patients with BMI >30. Conclusions: TORS-assisted lingual tonsillectomy ± multilevel procedures can be successful in treating patients with moderate to severe OSAHS with Friedman stage I-III anatomy. Success rates are even greater if patients are stratified according to preoperative BMI, as those with BMI <30 are more likely to achieve success even with Friedman stage II-III anatomy.

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Section: Discussionmentioning

confidence: 99%

Addressing the Retrolingual Space in Obstructive Sleep Apnea: Outcomes Stratified by Friedman Stage in Patients Undergoing Transoral Robotic Surgery

Spector

Glazer

Hoff³

2015

ORL

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“…They also found that the TORS result was significantly improved compared to radiofrequency ablation of the tongue base but not compared to submucosal minimally invasive lingual excision (SMILE). The largest series to date has recently been organized by Vicini et al [25]; this benchmark study included 7 centers from 5 countries. The results of 243 patients with at least 3 months of follow-up were analyzed retrospectively and again demonstrated both the safety and efficacy of the procedure (pre- vs. postoperative AHI 43.0 vs. 17.9, and pre- vs. postoperative ESS 12.3 vs. 5.7).…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea

Hoff

Glazer

Spector

2014

ORL

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Objective: To determine the predictors of success in patients undergoing transoral robotic surgery (TORS) and multilevel procedures for the management of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: A total of 121 patients (83 male, 38 female) underwent TORS between 2010 and 2013. All patients had robotic assisted lingual tonsillectomy, either as stand-alone surgery or in combination with palatal Z-plasty, lateral pharyngoplasty or uvulopalatopharyngoplasty. The apnea-hypopnea index (AHI) and body mass index (BMI) were measured preoperatively and 3 months postoperatively. Success was defined as AHI <20 and a decrease in AHI by 50%. Results: There was a significant difference in the preoperative and postoperative AHI in the entire cohort (42.7 vs. 22.2; p < 0.001). Overall, 84.3% of patients had an improvement in their AHI, 51.2% of patients met the criteria for success, and 14% met the criteria for cure defined as AHI <5. When stratifying by BMI, there was a significant difference in success when comparing patients with a BMI <30 versus those with a BMI >30 (69.4 vs. 41.7%; p = 0.004). The cure rate was 15.3% in patients with a BMI <30 and 11.1% in those with a BMI >30 (p = 0.54). Conclusions: TORS lingual tonsillectomy and multilevel procedures were successful in treating moderate-to-severe OSAHS in selected patients. Preoperative BMI helps the clinician to predict success in these patients, with two thirds of patients having a clinically useful benefit. i 2014 S. Karger AG, Basel

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“…TORS has been shown to be an effective and safe procedure for the treatment of OSA in patients with hypertrophy of the BOT and floppy epiglottis 3 4 . A low rate of major complications, such as intra-operative or post-operative massive bleeding, has been reported 3 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, this technique has gained popularity as an effective therapeutic option both for OSA and head and neck cancer 3 - 5 . The aims of our paper are: 1.…”

Section: Introductionmentioning

confidence: 99%

Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation

Montevecchi

Cammaroto

Meccariello

et al. 2017

Acta Otorhinolaryngol Ital

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La decannulazione è sempre stata considerata una procedura con un certo grado di rischio, specie nei pazienti con ridotti diametri delle via aeree, come nel caso della sindrome delle apnee ostruttive (OSA). Presentiamo 4 casi nei quali la chirurgia robotica transorale (TORS) ha permesso un appropriato management di pazienti tracheotomizzati da divers mesi. Gli obiettivi del nostro lavoro sono: 1. Dimostrare come il team otorinolaringoiatrico possa favorire il riconoscimento di pazienti ad alto rischio di decannulazione inefficace e 2. Evidenziare il ruolo nella TORS nel trattamento dellipertrofia della base della lingua, responsabile dellostruzione delle vie aeree superiori. Dalla nostra esperienza la TORS appare una tecnica efficace nella decannulazione di pazienti affetti da ipertrofia della base della lingua e da epiglottide flottante.

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Clinical Outcomes and Complications Associated with TORS for OSAHS: A Benchmark for Evaluating an Emerging Surgical Technology in a Targeted Application for Benign Disease

Cited by 89 publications

References 16 publications

Addressing the Retrolingual Space in Obstructive Sleep Apnea: Outcomes Stratified by Friedman Stage in Patients Undergoing Transoral Robotic Surgery

Addressing the Retrolingual Space in Obstructive Sleep Apnea: Outcomes Stratified by Friedman Stage in Patients Undergoing Transoral Robotic Surgery

Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea

Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation

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