Karaman Murat, Gün Taylan, Temelkuran Burak, Aynacı Engin, Kaya Cem, Tekin Ahmet Mahmut
Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey.
Department of otorhinolaryngology, Bahçeşehir University, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2017 May;274(5):2273-2279. doi: 10.1007/s00405-017-4449-3. Epub 2017 Feb 11.
To compare intra-operative and post-operative effectiveness of fiber delivered CO laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO laser. The use of CO laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.
比较在机器人辅助舌根手术中，光纤传输的CO激光与单极电灼术的术中及术后效果。前瞻性非随机临床研究。20例中度至重度阻塞性睡眠呼吸暂停（OSA）患者，不适合持续气道正压通气（CPAP）治疗，在我们大学医院使用达芬奇手术机器人接受经口机器人手术（TORS）。10例患者采用单极电灼术治疗OSA，另外10例患者采用柔性CO激光光纤治疗。分析两组的以下参数：需要烧灼止血的术中出血量、机器人手术时间、气管切开需求、术后自限性出血、住院时间、开始经口进食的时间、术前和术后最低动脉血氧饱和度、术前和术后爱泼华嗜睡量表评分、术后气道并发症和术后疼痛。平均随访12个月。所有患者均无需气管切开，且未出现与机器人或CO激光使用相关的术中并发症。与电灼术相比，在TORS辅助舌根手术中使用CO激光导致需要烧灼止血的术中出血量更少、机器人手术时间更短、住院时间更短、开始经口进食的时间更短以及术后疼痛更少。术后呼吸暂停低通气指数评分显示CO激光比电灼术疗效更好。两组术后气道并发症发生率和爱泼华嗜睡量表评分的比较在统计学上无显著差异。与单极电灼术相比，在机器人辅助舌根手术中使用CO激光在术中和术后具有多种优势。
