Obstructive sleep apnea (OSA) aﬀects about 20 million people in the United States and 60 million people worldwide. In adults, poor sleep quality can lead to concentration problems, memory loss, daytime sleepiness, and morning headaches. In children, OSA leads to decreased intelligence, decreased executive functioning, bedwetting, hyperactivity, and attention disorders. Also, OSA is linked to diabetes, coronary artery disease, hypertension, sexual dysfunction, and stroke. In children, it is also linked to heart failure and stunted growth.
We have come to understand that sleep apnea is a multilevel obstruction in adult patients. These levels include the nose, the space behind the palate, the space behind the tongue, and even at the level of the voice box. Surgeries directed at any single anatomic level have typically demonstrated poor success rates because of the fact that obstruction is occurring at multiple levels. Until recently, most of the effective techniques for addressing obstruction at the level of the tongue base have required external approaches which are morbid and leave visible scars.
Transoral robotic surgery (TORS) has revolutionized sleep apnea surgery by providing excellent visualization and access to lower areas of obstruction. We are now able to remove obstructive tongue base or epiglottic tissue in a precise manner that allows for no external incisions and short hospital stays. When combined with surgeries to address other levels of obstruction, success rates as high as 70% have been reported.
The robotic system translates the surgeon’s movements to multiple robotic arms which carry out the actual surgery. An assistant helping during the surgery uses their two hands to create a 4-handed surgery environment. Altogether, the robotic instrumentation and 4-handed technique allow for more control, movement, and precise manipulation of tissue in tight areas. The robot also provides increased vision for the surgeon due to innovative high definition camera placement and 3-D image modeling.
Are you a candidate for TORS? TORS sleep apnea surgery is for patients who have been diagnosed with OSA who cannot tolerate continuous positive airway pressure (CPAP) devices. In order to be assessed for TORS sleep apnea surgery, most patients can be assessed in the office. Sleep study results are reviewed and the patient undergoes endoscopic examination to identify the exact areas of obstruction. When the tongue base or epiglottis is identified as a site of obstruction, the patient is a candidate for the TORS sleep apnea procedure. Some patients will need drug-induced sleep endoscopy to identify sites of obstruction. In this procedure, a patient is given intravenous anesthesia in the operating room in order to mimic sleep. Flexible endoscopic examination is then carried out in this state to identify potential sites of obstruction.