Trans-Oral Robotic Surgery (TORS)

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Trans-Oral Robotic Surgery (TORS)

Postby stabb » Mon Jun 18, 2012 6:25 pm

I recently heard of a new surgery pioneered by U of Penn Medical Dr. Erica Thaler called Trans-Oral Robotic Surgery (TORS). According to early results...those who qualify (which i don't have the answer for which this might include) the success rate is upwards of 70%. Anybody have information on this they might share? I have tried diff CPAP machines on and off for 4+ yrs with very little success. Thank you.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby Dude » Tue Jun 19, 2012 9:27 am

There are some threads on this surgery.

Another surgery is going through trials now. It involves stimulating the tongue while sleeping so that it stays "awake" and doesn't fall into the throat.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby Ghibliss » Sun Jul 22, 2012 6:25 pm

I had tors surgery in Feb ....total failure, immense pain, lost 25 lbs...had repose surgery in May....also failed, cpap not working either!
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Re: Trans-Oral Robotic Surgery (TORS)

Postby Dude » Mon Jul 23, 2012 10:05 am

Is repose surgery where they anchor your tongue to the front of your jaw with a string of some sort?

Have you considered MMA surgery?
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Re: Trans-Oral Robotic Surgery (TORS)

Postby aktravel » Mon Jul 23, 2012 11:10 am

I am thinking about going to these docs they are suppose to be the best in the world this is what that do
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the want to do 3 surgeries to open up the air ways with an 85% success rate? still thinking about it. Any ideas?
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Re: Trans-Oral Robotic Surgery (TORS)

Postby blueh2o » Mon Jul 23, 2012 3:10 pm

Please provide more details on what surgeries they want to do. I too, have seen the best in the world and the only surgeries I know with documented success rates of 85% plus is the Maxillo Mandibular Advancement and Tracheotomy.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby aktravel » Fri Jul 27, 2012 3:48 pm

1. Septoplasty, turbnate reduction
2. Uvulopalatal flap, tonslectomy
3. genioglossns advancement

Hard to read the docs hand writing so if the spelling is not right sorry..

In short they want to remove tonsils, cut and flip Uvla and cut open palate, then remove fat from back of tong. Also fix deviation in the nose.

Hope that helps.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby blueh2o » Fri Sep 14, 2012 3:54 pm

AK,
I have yet to see more than one study that has a multi-level surgery such as what you describe have a better than 70% success rate. Additionally, you have to figure out how "success" is defined as different studies define it differently. I'd ask the docs. to show you the studies they reference. I do wish you luck...
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Re: Trans-Oral Robotic Surgery (TORS)

Postby blueh2o » Fri Sep 14, 2012 3:57 pm

I should add that for anyone who is considering surgery there is a good book that provides more information than you'd ever want to know. "Sleep Apnea and Snoring, Surgical and Non-surgical Treatment" (something like that) edited by Friedman (of the Friedman Tongue Position fame). You can get it online. Pretty expensive but worth what you'll learn before going in to what I would consider a major surgery.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby linmd » Sat Dec 01, 2012 10:46 pm

Ghibliss wrote:I had tors surgery in Feb ....total failure, immense pain, lost 25 lbs...had repose surgery in May....also failed, cpap not working either!


Hi, can you tell us where your surgery was done. You don't have to be specific with name of the doctor but maybe just the city.
Also, what was you AHI before and after the surgery. Thanks.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby linmd » Sat Dec 01, 2012 11:01 pm

stabb wrote:I recently heard of a new surgery pioneered by U of Penn Medical Dr. Erica Thaler called Trans-Oral Robotic Surgery (TORS). According to early results...those who qualify (which i don't have the answer for which this might include) the success rate is upwards of 70%. Anybody have information on this they might share? I have tried diff CPAP machines on and off for 4+ yrs with very little success. Thank you.


TORS for treatment of obstructive sleep apnea is a very new procedure. Currently, there are only 3 papers in the world that have been published on the use of robot to treat sleep apnea. There are few surgeons in the US that have adequate experience in this surgery and many surgeons are beginning to learn this technique. Just like any surgery, proper patient and disease selection are very important. Obviously, if a patient do not have base of tongue obstruction, using the robot to cut out the tissue in the back of the tongue will not help. Currently, more and more surgeons are using a technique called sleep endoscopy to assess the exact site and pattern of tissue collapse in the back of the throat. In this procedure, the patient is given some sedation to make him/her fall asleep in the operating room. While sleeping, the surgeon inserts a small camera down the back of the throat to visualize the area of obstruction while the patient is sleeping. Based on that determination, the surgeon can then determine and recommend the type or types of surgery required. The surgery may or may not involve TORS. Hopefully, this helps.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby richl » Fri Dec 07, 2012 5:04 pm

I spoke with Viba Nguyen, the Clinical Research Coordinator for Penn Med's TORS Sleep Apnea Clinical Study.

As of today, on the 62 patients participating in the study ~60% have seen successful results. Viba defined success for the ~60% as pre-surgery CPAP treatment not effective: post surgery 1/2 the group no CPAP required, the other 1/2 using CPAP effectively.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby need_air_at_night » Fri Dec 07, 2012 6:38 pm

richl wrote:I spoke with Viba Nguyen, the Clinical Research Coordinator for Penn Med's TORS Sleep Apnea Clinical Study.

As of today, on the 62 patients participating in the study ~60% have seen successful results. Viba defined success for the ~60% as pre-surgery CPAP treatment not effective: post surgery 1/2 the group no CPAP required, the other 1/2 using CPAP effectively.

That is not a very good result 37.2 people had problems and could not handle a CPAP. after surgery only 18 people had success. that is not a lot of people to feel good about having some one microwave my tonuge.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby linmd » Sat Jan 12, 2013 8:21 pm

This may not be such a bad result. Remember, 37.2 people out of 62 patients or 60% got better after the surgery. These patients, if they did not go through surgery, would still be suffering from nightly struggle to get air into the lung. Yes, only 18.6 people got so much better after surgery that they do not even need CPAP. However, the other 18.6 people that still require CPAP are still helped by the procedure because prior to surgery they could not use CPAP effectively. The way I see it, the goal of surgery is to take these patients who are inadequately treated for sleep apnea (unable to tolerate CPAP) and make it so that either they do not need the CPAP anymore (since their sleep apnea is so much better) or that they still need CPAP but can now tolerate it after the surgery.
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Re: Trans-Oral Robotic Surgery (TORS)

Postby Daniel » Sun Jan 13, 2013 6:40 am

linmd wrote:This may not be such a bad result. Remember, 37.2 people out of 62 patients or 60% got better after the surgery. These patients, if they did not go through surgery, would still be suffering from nightly struggle to get air into the lung. Yes, only 18.6 people got so much better after surgery that they do not even need CPAP. However, the other 18.6 people that still require CPAP are still helped by the procedure because prior to surgery they could not use CPAP effectively. The way I see it, the goal of surgery is to take these patients who are inadequately treated for sleep apnea (unable to tolerate CPAP) and make it so that either they do not need the CPAP anymore (since their sleep apnea is so much better) or that they still need CPAP but can now tolerate it after the surgery.


TORS is still in its infancy, and from what I have read, is a new angle (method) on traditional surgical procedures (similar to the LAUP as an option over UPPP).
There are no large study results available, and certainly nothing showing success/failure after any appreciable length of time (3 years +).

US health insurers are non too keen on the procedure (most don't even mention it), but United Healthcare make the following statement:

UNITED HEALTHCARE
The following surgical procedures are unproven for treating obstructive sleep apnea:
• Laser-assisted uvulopalatoplasty (LAUP)
• Palatal implants (e.g., Pillar®)
• Lingual suspension (e.g., AIRvance™ Tongue Suspension (formerly Repose®) - also
referred to as tongue stabilization, tongue stitch or tongue fixation
Transoral robotic surgery (TORS)

Transoral Robotic Surgery (TORS)
Based on studies using transoral robotic surgery to treat head and neck cancers, researchers are
investigating the use of this technology for patients with obstructive sleep apnea. Only one
feasibility study was identified in the clinical literature.
Vicini et al. (2010) evaluated the feasibility, tolerability and efficacy of tongue base management
using transoral robotic surgery (TORS) in patients with obstructive sleep apnea-hypopnea
syndrome (OSAHS). Seventeen patients with OSAHS, principally related to tongue base
hypertrophy, underwent TORS (Intuitive da Vinci®). Patients with a minimum follow-up of 3
months were evaluated. Ten patients [mean preoperative apnea-hypopnea index (AHI): 38.3 +/-
23.5 SD] were included in the study. The postoperative polysomnographic results were fairly
good (mean postoperative AHI: 20.6 +/- 17.3 SD), and the functional results (pain, swallowing
and quality of life) were encouraging. Complications were rare and of minor importance.
Transoral robotic tongue base management in patients with OSAHS primarily related to tongue
base hypertrophy is feasible and well tolerable. The authors found these preliminary results
encouraging and worthy of further evaluation.


IMHO, TORS requires a lot more investigative type studies. I believe that it is traditional surgery carried out with a new device (robot), which may or may not be more precise.

Daniel.
The untreated Sleep Apnoea sufferer died quietly in his sleep..
Unlike his three passengers who died screaming !


The first 40 years of childhood are by far the hardest
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