title: Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment.
abstract: OBJECTIVE
  Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance).
  
  
  METHODS
  Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO2) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life.
  
  
  RESULTS
  Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3 ± 21.4 to 21.2 ± 24.6, p = 0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.002). Mean SaO2 significantly increased after surgery compared to pre-operative values (92.9 ± 1.8 to 94.3 ± 2.5, p = 0.005). Quality of life showed a sustained improvement 3 months following surgery (p = 0.01). No major complications occurred.
  
  
  CONCLUSIONS
  TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK. asitarora@doctors.org.uk.
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Chaidas
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors.forename: George
authors.initials: G
authors.lastname: Garas
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors.forename: Ashik
authors.initials: A
authors.lastname: Amlani
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK.
authors.forename: Bhik
authors.initials: B
authors.lastname: Kotecha
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Tolley
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure; D004724:Endoscopy / Q000295:instrumentation*; D004825:Epiglottis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013523:Surgical Equipment; D014059:Tongue / Q000601:surgery*
keywords: Epiglottoplasty; Obstructive sleep apnea; Robotic surgery; Tongue base reduction; Transoral