title: Transoral robotic surgery for sleep apnea in children: Is it effective?
abstract: OBJECTIVE
  Children with obstructive sleep apnea/hypopnea syndrome (OSAHS) as a result of base of tongue (BOT) or lingual tonsillar hypertrophy do not improve following adenotonsillectomy. In adults, transoral robotic surgery (TORS) offers a means of treating such patients, however the efficacy of this technique for children is not known. In this study, we examine the effectiveness of TORS BOT reduction and lingual tonsillectomy for treatment of pediatric OSAHS.
  
  
  METHODS
  This was a retrospective study of nine patients (5 non-syndromic; 4 syndromic) who underwent isolated BOT reduction and lingual tonsillectomy for OSAHS between 2012 and 2014 at a tertiary care pediatric medical center. Differences between pre and post surgical polysomnograms (PSGs) were utilized to measure the procedural effectiveness. Patient age, sex, body mass index (BMI), developmental status, and comorbid conditions were also examined.
  
  
  RESULTS
  The average patient age was 10.5 years (range 5.2-18.5). There were 5 males and 4 females. The mean pre-operative obstructive AHI (O-AHI) was 27.1 compared to 10.9 post-operatively (mean difference=16.1, t=2.27, p≤0.05). Statistically significant reductions were also noted in hypopneic events (mean difference=61.3, t=2.64, p<0.05) and lowest oxygen saturation (mean difference=9.0, t=-3.29, p≤0.01). One patient developed a post-operative bleed that was controlled operatively.
  
  
  CONCLUSIONS
  In children with airway obstruction associated with BOT and lingual tonsillar hypertrophy, TORS is a useful and effective tool. Patients' who underwent TORS demonstrated a significant decrease in obstructive events. All patients reviewed exhibited at least a 50% reduction in O-AHI.
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pediatric Otolaryngology, 4401 Penn Ave, Pittsburgh, PA 15224, USA; Michigan Pediatric Ear, Nose and Throat Associates, 29120 Franklin Rd, Southfield, MI 48034, USA; Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St, Detroit, MI 48201, USA. Electronic address: pthottam@gmail.com.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: University of Pittsburgh Medical Center, Otolaryngology, 200 Lothrop St, Pittsburgh, PA 15213, USA.
authors.forename: Nandini
authors.initials: N
authors.lastname: Govil
authors.affiliation: University of Pittsburgh Medical Center, Otolaryngology, 200 Lothrop St, Pittsburgh, PA 15213, USA; Department of Otolaryngology, Department of Veterans Affairs Pittsburgh Health System, University Drive, Pittsburgh, PA 15240, USA.
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pediatric Otolaryngology, 4401 Penn Ave, Pittsburgh, PA 15224, USA; University of Pittsburgh Medical Center, Otolaryngology, 200 Lothrop St, Pittsburgh, PA 15213, USA; Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D008297:Male; D057605:Natural Orifice Endoscopic Surgery; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery; D017286:Polysomnography; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery*; D014059:Tongue / Q000473:pathology* / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Base of tongue and lingual tonsillar hypertrophy; Obstructive sleep apnea; Pediatric sleep medicine; Robotic surgery