Prospective randomized comparison of tongue base resection techniques: Robotic vs coblation

Abstract

Objective The objective of this study was to determine the effectiveness and morbidities of two different tongue base surgical approaches in patients with obstructive sleep apnoea (OSA). Design and Setting We carried out a prospective analysis in order to understand in detail the relative impact on apnoeas of the two different tongue base procedures. Seventy cases in 85 patients with OSA were divided into two operating groups and randomized. Altogether, 37 transoral robotic surgeries (TORS) and 33 coblations were performed. The patency of retrolingual passage was investigated by Muller's manoeuvere, polysomnography. Apnoea‐hypopnea index (AHI) was the primary outcome measure with the Epworth Sleepiness Score (ESS). The final follow‐up visit was at 6 months. Results The AHI index improved from 29.7 ± 9 to 10.7 ± 3.9 (P < .005) following TORS and from 27.2 ± 6.4 to 10.3 ± 4 in the coblation group. Selecting a threshold of a 50% reduction in AHI and AHI less than 20 events/h, the overall success rate was 75.6% in TORS compared with 78.7% in coblation (P = .785). Similar results were seen in AHI reduction rates (36%, 37.8%, respectively). ESS showed a significant improvement 6 months following surgery in both groups. Conclusion Transoral robotic surgery technique showed higher complication rates than coblation. TORS and coblation of the tongue base represent a promising treatment option with a similar AHI improvement. However, coblation promises lower complication rates unlike TORS.

Comparison of transoral robotic surgery with other surgeries for obstructive sleep apnea

“…In January 2020, 76 articles were identified in a preliminary search, and 8 of these articles met the criteria for review 4,[11][12][13][14][15][16][17] . The results of QUADAS-2 assessment of the included articles are illustrated in Table 1.…”

“…2) and revealed a significant treatment effect in these studies (p < 0.05). Among the included studies, six were retrospective [11][12][13][14][15]17 , one had a pre-post-test design 16 , and one was prospective 4 . In total, 188 patients with obstructive sleep apnea treated with TORS and 230 cases treated with alternative interventions were included in the analysis.…”

“…In total, 188 patients with obstructive sleep apnea treated with TORS and 230 cases treated with alternative interventions were included in the analysis. Three studies investigated coblation tongue base resection (CTBR, total n = 79) [11][12][13] , and two studies investigated upper airway stimulation (UAS, total n = 105) 14,15 . Three articles reported on radiofrequency (n = 20), CO 2 laser (n = 10), and endoscopic partial midline glossectomy (EPMG, n = 16) 4, 16,17 .…”

“…Articles without data on surgical outcomes, studies on only one particular operation, and reviews on TORS as a treatment for unrelated medical conditions were all excluded. Severity of sleep apnea was diagnosed using attended overnight polysomnography for each patient in the eight studies included, and the scoring system was defined by the American Academy of Sleep Medicine (AASM) 4,[11][12][13][14][15][16][17] . Babademez et al used the AASM 2.2 edition 12 , and Hwang et al and Lan et al used the AASM 2.5 edition to measure overnight PSG 11,13 .…”

Robotic Surgery in Obstructive Sleep Apnea-Hypopnoea Syndrome

“…Determining the anatomical and physiological site of obstruction is crucial for matching a patient to the appropriate surgical intervention. Multilevel obstructions are commonly identified in up to 54% of patients [13]. During physical examination, special attention should The goal of TBR is to enlarge the oropharyngeal space by removing tissue from the anterior wall.…”