Multilevel Combined Surgery With Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome

Objective: To evaluate the results of combined multilevel surgery with transoral robotic surgery (TORS) in patients with obstructive sleep apnea/hypopnea syndrome for multilevel upper airway obstruction. Methods: Subjects who underwent combined sleep surgery via TORS were evaluated. The drug-induced sleep endoscopy was used in diagnosing the presence of level-specific upper airway collapse and to detect the type of surgery. Pre- and postoperative Apnea-hypopnea index, Epworth sleepiness scale lowest oxygen saturation, total operation time, robotic set-up time and robotic surgery time, blood loss value, and complications were recorded. Results: Twenty five subjects were identified. All subjects underwent base of tongue (BOT) + epiglottoplasty. The tracheotomy was not performed for any patient. Overall, 72% of patients met the criteria for cure, 8% met the criteria for cure, and 20% of patients met the criteria for failure. There was a significant decrease between preoperative and postoperative Apnea-hypopnea index scores (28.7 +/- 17.8 SD versus 9.4 +/- 12.4, P = 0.000) and Epworth sleepiness scale scores (13.5 +/- 2.8 versus 3.4 +/- 1.6, P = 0.000). There was a significant increase between preoperative and postoperative ED SPO2 levels (80.7 +/- 7.6 versus 82.6 +/- 18.1, P = 0.001). Conclusion: TORS BOT, epiglottoplasty, and multilevel procedures in patients with obstructive sleep apnea/hypopnea syndrome can be regarded as feasible, safe, and effective technique.