A Safe and Precise Tongue Base Surgery for OSA: Real-time Intraoperative Ultrasound-Assisted TORS скачать в хорошем качестве

A Safe and Precise Tongue Base Surgery for OSA: Real-time Intraoperative Ultrasound-Assisted TORS

TSSM2021研討會12分鐘版-1100307 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Obstructive sleep apnea is a health issue that has been gradually recognized by people in recent years. Continuous positive airway pressure (CPAP) is the standard of care for medical treatment of OSA. While generally not as effective as CPAP, upper airway surgery is an option as salvage therapy in CPAP failures. Obstructions can occur at many areas along the upper airway, and 58% to 87% of patients with OSA have multilevel collapse. Residual obstructions along the tongue base account for 17% to 33% of upper airway collapse and are especially prominent in the obese and severe OSA populations. Transoral robotic surgery (TORS) provides a novel technique for surgical resection of the base-of-tongue (BOT) and lingual tonsil. TORS was initially used for resection of BOT neoplasms in 2006. The concept of TORS as a treatment of OSA was first introduced in 2009 by Vicini et al. in their feasibility report for the treatment of BOT hypertrophy. Since then, TORS has been shown to be an effective treatment option for both isolated retrolingual obstruction and when combined with other techniques in cases of multilevel obstruction. Despite the many advantages of TORS, such as enhanced visualization, current robotic surgical systems do not provide haptic feedback to the surgeon. Haptic feedback allows the surgeon to palpate vascular structures within the operative field. One of the most devastating complications that may occur during TORS is massive hemorrhage from inadvertent injury to the vasculature. Although the excellent 3D visualization provided by the robotic system is helpful in locating these vessels, the absence of haptic feedback does place the surgeon at a disadvantage. Since 2018, ENT department, NCKUH, uses intraoperative imaging with real-time ultrasound to augment the 3D visualization of the robotic system. Ultrasound imaging may allow for identification of the vascular structure (esp. lingual artery) within the BOT, thereby extending the tissue resection and reducing morbidity. In this speech, we will provide our experience of the intraoperative ultrasound assisted TORS for OSA.