Robotic Tongue-Base Resection Combined With Tongue-Base Suspension for Obstructive Sleep Apnea

Objectives/Hypothesis Our primary objective was to evaluate the feasibility, morbidity, and efficacy of transoral robotic surgery (TORS) tongue-base resection (TBR) combined with tongue-base suspension (TBS) for obstructive sleep apnea (OSA) with tongue-base collapse. Our secondary objective included evaluation of factors influencing treatment success. Study Design Single-arm, prospective, observational cohort study. Methods Patients were eligible if they had moderate-to-severe OSA (apnea hypopnea index [AHI] > 15) or positional OSA, had a tongue-base collapse and glossoptosis identified by drug-induced sleep endoscopy (DISE), and failed continuous positive airway pressure. All patients underwent TORS-TBR combined with TBS. Additionally, concomitant epiglottoplasty, uvulopalatopharyngoplasty, or expansion pharyngoplasty were performed based on DISE findings. Results In total, 64 patients were enrolled in the trial. The mean age was 45.9 years, mean body mass index was 30.5 kg/m(2), and mean AHI was 41.7 events/hour. The mean robotic surgical time, total volume of tongue-base tissue removed, and the length of hospital stay were 21.4 minutes, 15.16 mL, and 6.5 days, respectively. Postoperatively, almost all polysomnographic metrics improved significantly (AHI = 41.72 vs. 18.82 events/hour, lowest oxygen saturation = 80.43% vs. 85.14%, Epworth Sleepiness Scale = 10.49 vs. 4.09). The procedure provided an overall success rate of 75%, with minor morbidity. All patients experienced varying degrees of temporary lingual edema postoperatively. Tracheotomy was not required for any patient. Although no independent predictor of treatment success was determined, patients with more severe disease tend to exhibit lower response to the treatment. Conclusions TORS-TBR combined with TBS is a feasible, safe, and efficient procedure for OSA with tongue-base collapse. Level of Evidence 4 Laryngoscope, 2019