Robo-Cob technique; transoral endoscopic coblation tongue base resection in obstructive sleep apnea patients
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ENT • ORIGINAL ARTICLE
Robo-Cob technique; transoral endoscopic coblation tongue base resection in obstructive sleep apnea patients Ahmed Bahgat 1
&
Yassin Bahgat 1
Received: 4 October 2019 / Revised: 27 April 2020 / Accepted: 5 May 2020 # Springer Nature Switzerland AG 2020
Abstract Background Another transoral tongue base surgical procedure for obstructive sleep apnea (OSA) is described. The procedure was named as the “Robo-Cob” technique because it is similar to transoral robotic surgery (TORS) but using a coblation technology to manage tongue base hypertrophy in patients with OSA especially in countries where TORS is not an available option for such benign conditions. Methods The technique is described step by step. The new surgical technique was carried out in 25 adult OSA patients with mean age of 41.36 ± 8.72 years (average 23–56) with confirmed tongue base hypertrophy by preoperative drug-induced sleep endoscopy (DISE). Coblation was used to resect, not ablate, the tongue base with similar technique as described in TORS. Results The Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgery settings. There were no significant intraoperative or postoperative complications. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by polysomnography 3 months postoperatively with significant decrease in mean AHI from 33.84 ± 10.54 to 11.52 ± 5.42 (P < 0.005). Moreover, this technique provided tongue base tissue specimen that allowed measurement of its volume that ranged from 10 to 22 cc (mean 14.96 ± 3.62 cc) to monitor extent of tissue resection. Conclusion The added value of using coblation in resection, not ablation, is being quicker, and being able to provide tissue specimen to measure its volume to judge resection limits. Keywords Tongue base surgery . Coblation surgery . Obstructive sleep apnea . Transoral robotic surgery
Presentation at a conference: This paper was presented as oral presentation during: • The First International Egyptian Laryngological & Sleep surgery society congress ELSSS, January 2018 • 8th Emirates Rhinology & Otology Congress EROC, January 2018 • RhinoEgypt, March 2018 • AlexORL, April 2019 • RhinoEgypt, March 2018 • 9th Emirates Rhinology & Otology Congress EROC, January 2019 • AlexORL, April 2019 • 106th Italian Society of Otolaryngology, June 2019 This paper was presented as poster presentation during: • American Academy of Otolaryngology-Head&Neck Surgery Meeting, September 2018 • 5th Congress of European ORL-HNS, July 2019 * Ahmed Bahgat [email protected] 1
Department of Otorhinolaryngology, Alexandria university, Elazaritta, Alexandria 00203, Egypt
Introduction Tongue base hypertrophy plays an important role in pathophysiology in many, up to half the number of, cases of obstructive sleep apnea (OSA) syndrome especially severe ones [1]. The tongue base including both the lingual tonsils and the tongue base muscles may be the primary obstructing si
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