title: Multilevel Combined Surgery With Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome.
abstract: OBJECTIVE
  To evaluate the results of combined multilevel surgery with transoral robotic surgery (TORS) in patients with obstructive sleep apnea/hypopnea syndrome for multilevel upper airway obstruction.
  
  
  METHODS
  Subjects who underwent combined sleep surgery via TORS were evaluated. The drug-induced sleep endoscopy was used in diagnosing the presence of level-specific upper airway collapse and to detect the type of surgery. Pre- and postoperative Apnea-hypopnea index, Epworth sleepiness scale lowest oxygen saturation, total operation time, robotic set-up time and robotic surgery time, blood loss value, and complications were recorded.
  
  
  RESULTS
  Twenty five subjects were identified. All subjects underwent base of tongue (BOT) + epiglottoplasty. The tracheotomy was not performed for any patient. Overall, 72% of patients met the criteria for cure, 8% met the criteria for cure, and 20% of patients met the criteria for failure. There was a significant decrease between preoperative and postoperative Apnea-hypopnea index scores (28.7 ± 17.8 SD versus 9.4 ± 12.4, P = 0.000) and Epworth sleepiness scale scores (13.5 ± 2.8 versus 3.4 ± 1.6, P = 0.000). There was a significant increase between preoperative and postoperative ED SPO2 levels (80.7 ± 7.6 versus 82.6 ± 18.1, P = 0.001).
  
  
  CONCLUSIONS
  TORS BOT, epiglottoplasty, and multilevel procedures in patients with obstructive sleep apnea/hypopnea syndrome can be regarded as feasible, safe, and effective technique.
authors.affiliation: *Department of Otolaryngology Head and Neck Surgery, Bakirköy Sadi Konuk Training and Research Hospital †Informatics Institute, Istanbul Technical University, Istanbul, Turkey.
authors.forename: Fatma Tülin
authors.initials: FT
authors.lastname: Kayhan
authors.forename: Kamil Hakan
authors.initials: KH
authors.lastname: Kaya
authors.forename: Arzu Karaman
authors.initials: AK
authors.lastname: Koç
authors.forename: Yakup
authors.initials: Y
authors.lastname: Yegin
authors.forename: Zahide Mine
authors.initials: ZM
authors.lastname: Yazici
authors.forename: Serkan
authors.initials: S
authors.lastname: Türkeli
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sayin
mesh_terms: D004825:Epiglottis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014059:Tongue / Q000601:surgery; D016896:Treatment Outcome