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:
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.