title: Comparison of fiber delivered CO2laser and electrocautery in transoral robot assisted tongue base surgery.
abstract: To compare intra-operative and post-operative effectiveness of fiber delivered CO2laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2laser. The use of CO2laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.
authors.affiliation: Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey. karaman1398@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Karaman
authors.affiliation: Department of otorhinolaryngology, Bahçeşehir University, Istanbul, Turkey.
authors.forename: Taylan
authors.initials: T
authors.lastname: Gün
authors.affiliation: OmniGuide Surgical, London, UK.|OmniGuide Surgical, Lexington, MA, USA.
authors.forename: Burak
authors.initials: B
authors.lastname: Temelkuran
authors.affiliation: Department of pulmonology, Istanbul Medipol University, Istanbul, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Aynacı
authors.affiliation: Department of anesthesiology, Istanbul Medipol University, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Kaya
authors.affiliation: Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey.
authors.forename: Ahmet Mahmut
authors.initials: AM
authors.lastname: Tekin
mesh_terms: D000328:Adult; D057186:Comparative Effectiveness Research; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014059:Tongue / Q000601:surgery; D016896:Treatment Outcome; D014421:Turkey
keywords: Fiber delivered CO2 laser; Monopolar electrocautery; Obstructive sleep apnea; Robot assisted surgery; Tongue base surgery