Real-Time, Intraoperative, Ultrasound-Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

Area of Science:

• Surgical Innovation
• Medical Imaging
• Otolaryngology

Background:

• Transoral robotic surgery (TORS) is used for obstructive sleep apnea (OSA) tongue base resection.
• Identifying the lingual artery (LA) is crucial to prevent bleeding complications.
• Intraoperative ultrasound (IOU) offers real-time imaging during TORS.

Purpose of the Study:

• To investigate the lingual artery (LA) position in the tongue base using intraoperative ultrasound (IOU) during TORS.
• To evaluate bleeding complications with and without IOU assistance in TORS for OSA.

Main Methods:

• A cohort study with historical controls was conducted.
• Patients with OSA undergoing TORS for tongue base resection were analyzed.
• IOU was used to identify LA parameters: distance to midline, depth, and diameter.

Main Results:

• Seventy patients with IOU had shorter operation times (191.7 min) and less blood loss (11.3 mL) compared to 23 without IOU (220.1 min, 19.6 mL).
• Higher AHI during REM sleep, larger tonsil size, and elevated Friedman tongue position predicted arterial depth.
• No postoperative complications related to LA injury were observed in the IOU group.

Conclusions:

• IOU enables confident identification of the lingual artery during TORS for OSA.
• IOU enhances surgical efficiency and minimizes severe bleeding risks in tongue base resections.