Evaluation of single-port TORS tongue base resection for obstructive sleep apnea: safety and patient outcomes

Abstract

Tongue base resection for obstructive sleep apnea (OSA) using the da Vinci robotic system has been widely reported as a treatment option. Nevertheless, the relatively high incidence of perioperative hemorrhage associated with the single-port (SP) model may limit its adoption compared with the multi-port system. The study is aiming in evaluating the feasibility and safety of our modified protocol of transoral robotic surgery (TORS) tongue base resection for OSA using the SP da Vinci robotic system. Study design is prospective phase II observational trial. Setting is tertiary referral hospital. Adult patients with an apnea-hypopnea index (AHI) > 15, body mass index (BMI) < 35, and indicated for tongue base resection were enrolled. Single-level or multi-level oropharyngeal surgeries were performed by a single surgeon using the SP da Vinci system. Patient-reported outcomes, including sleep quality and pain, were collected preoperatively and postoperatively. Perioperative complications were monitored and recorded. Preliminary data from 12 patients were analyzed. No perioperative hemorrhages required secondary procedures under general anesthesia within 30 days post-surgery. One mild bleeding episode occurred and resolved spontaneously on post-operative day 8. Visual analog scale (VAS) pain scores decreased from 6.5 ± 2.3 on day 1 to 3.4 ± 2.3 on day 7. The Epworth Sleepiness Scale (ESS) score improved significantly from 9.6 ± 3.0 preoperatively to 3.9 ± 2.3 (p = 0.001) and the Pittsburg sleep quality index (PSQI) from 12.3 ± 3.1 to 4.7 ± 4.2 (p < 0.001) at 1 month postoperatively. TORS tongue base resection using the da Vinci SP system is a feasible and safe surgical option for OSA patients with tongue base obstruction, demonstrating a low complication rate and improvement in daytime sleepiness.