Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis

doi:10.1002/hed.26702

Meta-Analysis

. 2021 Jul;43(7):2216-2239.

doi: 10.1002/hed.26702. Epub 2021 Apr 16.

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis

Jerome R Lechien^{1

2

3

4}, Carlos-Miguel Chiesa-Estomba^{1

5}, Nicolas Fakhry^{1

6}, Sven Saussez^{2

4}, Ibrahim Badr^{1

7}, Tareck Ayad^{1

8}, Younes Chekkoury-Idrissi^{1

3}, Antoine E Melkane^{1

9}, Ahmed Bahgat^{1

10}, Lise Crevier-Buchman³, Marc Blumen³, Giovanni Cammaroto^{1

11}, Claudio Vicini¹¹, Stéphane Hans^{1

3}

Affiliations

¹ Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.
² Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
³ Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France.
⁷ Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford School of Medicine, Stanford, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
⁹ Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
¹⁰ Department of Otorhinolaryngology, Faculty of Medicine, Alexandria Hospital, Alexandria, Egypt.
¹¹ Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy.

PMID: 33860981
DOI: 10.1002/hed.26702

Meta-Analysis

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis

Jerome R Lechien et al. Head Neck. 2021 Jul.

. 2021 Jul;43(7):2216-2239.

doi: 10.1002/hed.26702. Epub 2021 Apr 16.

Authors

Affiliations

¹ Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.
² Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
³ Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France.
⁷ Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford School of Medicine, Stanford, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
⁹ Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
¹⁰ Department of Otorhinolaryngology, Faculty of Medicine, Alexandria Hospital, Alexandria, Egypt.
¹¹ Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy.

PMID: 33860981
DOI: 10.1002/hed.26702

Abstract

We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea-Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69-26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50-9.34). The summary estimate of increase in lowest O₂ saturation was 6.04% (95% CI: 3.05-9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64-79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O₂ saturation.

Keywords: TORS; apnea; outcome; review; robot; robotic; sleep; surgery; tongue; tonsil.

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References

REFERENCES

1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014. https://doi.org/10.1093/aje/kws342.
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1. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034-2041.
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1. Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res. 2015;93:1778-1794.

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[1] Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014. https://doi.org/10.1093/aje/kws342.

[2] Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014. https://doi.org/10.1093/aje/kws342.

[3] Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015;6(5):273-285. https://doi.org/10.1177/2040622315590318.

[4] Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015;6(5):273-285. https://doi.org/10.1177/2040622315590318.

[5] Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034-2041.

[6] Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034-2041.

[7] Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep HeartHealth study. Am J Respir Crit Care Med. 2001;163:19-25.

[8] Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep HeartHealth study. Am J Respir Crit Care Med. 2001;163:19-25.

[9] Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res. 2015;93:1778-1794.

[10] Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res. 2015;93:1778-1794.

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Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis

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Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis

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