title: Transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for obstructive sleep apnea.
abstract: OBJECTIVE
  We assessed the use of transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for the surgical management of tongue base obstruction in patients with obstructive sleep apnea.
  
  
  METHODS
  In a prospective, nonrandomized trial using historical controls, patients underwent drug-induced sleep endoscopy, transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty, and preoperative and postoperative polysomnography.
  
  
  RESULTS
  Twenty patients have completed the study to date. The rate of surgical success was 45%, and the rate of surgical response was 65%. The mean preoperative apnea-hypopnea index of 55.6 decreased by 56.7%, to a mean postoperative value of 24.1 (p < 0.001), and the minimum arterial oxygen saturation increased from the mean preoperative value of 75.8% to the mean postoperative value of 81.7% (p = 0.013). The mean Epworth Sleepiness Scale score improved from 13.4 to 5.9 (p = 0.003). One patient had postoperative bleeding that required cauterization, resulting in a major complication rate of 4.2%.
  
  
  CONCLUSIONS
  Transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty is a novel technique for the surgical management of obstructive sleep apnea that results in a significant decrease in the apnea-hypopnea index, a significant improvement in minimum arterial oxygen saturation, and a significant improvement in the Epworth Sleepiness Scale score and has an acceptable complication rate.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Lee
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.forename: Erica R
authors.initials: ER
authors.lastname: Thaler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012371:Robotics; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D014609:Uvula / Q000601:surgery*
chemical_list: D010100:Oxygen