Literature Review: A Roundup of Important Recent Studies

—Reviewed by Amy Eckner

Transoral BOT Resection Effective for OSA

How effective is base of tongue (BOT) resection by transoral robotic surgery (TORS) in obstructive sleep apnea/hypopnea syndrome (OSAHS)?

Background: OSAHS surgical treatment can be challenging and even controversial. According to the authors, there is a critical need to improve surgical treatment of OSAHS patients through either a shift in treatment paradigm or technological advances. Reports have described the use of TORS-assisted BOT resection with other concomitant upper airway procedures, but the authors note that there are no previous studies on TORS-assisted BOT resection without any other concomitant surgical alterations at other levels of upper airway.

Study design: Case series of 27 patients (12 with clinical and polysomnographic data) who received BOT resection via TORS between June 2010 and May 2012. Patients were excluded if other concomitant upper airway procedures were performed, or if post-operative polysomnograms (PSGs) were not available.

Setting: Wayne State University; Barbara Ann Karmanos Cancer Institute, Detroit, Mich.

Synopsis: A single surgeon performed all of the cases. The primary efficacy endpoint was changes in apnea-hypopnea index (AHI), with secondary efficacy endpoints of changes in LO2sat, Epworth Sleepiness Scale (ESS), BMI and snoring intensity. Surgical response was achieved when post-operative PSG showed >50 percent reduction in AHI with a final AHI <20. The majority of patients had previously undergone other types of upper airway procedures. No intra-operative difficulty or complication was encountered. Median total operative time was 75 minutes, median blood loss was 20 ml, the median total volume of BOT tissue removed was 22.1 mL and the median hospital stay was three days. Mean AHI was 43.9 ± 41.1 pre-operatively and 17.6 ± 16.2 post-operatively for an average AHI reduction of 28.3 percent. There was a significant reduction in ESS and snoring intensity but no significant difference between pre-operative and post-operative BMI or LO2sat. Six of 12 patients achieved surgical response, and all had post-operative AHI of less than 10. Surgical outcomes appeared similar to those patients who underwent the BOT procedure in addition to other upper airway surgeries.

Bottom line: There was a statistically significant improvement in ESS, AHI and snoring intensity for patients who received a BOT resection via TORS for the treatment of OSAHS.

Citation: Lin HS, Rowley JA, Badr MS, et al. Transoral robotic surgery for treatment of obstructive sleep apnea-hypopnea syndrome. Laryngoscope. 2013;123:1811-1816.