Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt,
Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt.
ORL J Otorhinolaryngol Relat Spec. 2020;82(4):201-208. doi: 10.1159/000506994. Epub 2020 May 6.
A new transoral tongue base surgical procedure for the treatment of snoring and obstructive sleep apnea (OSA) is described. It is named "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but it is performed by means of coblation technology in order to resect the tongue base in countries where TORS is not an available option for such benign conditions.
In this prospective, randomized, controlled trial, the new Robo-Cob technique was carried out in 25 adult OSA patients with confirmed tongue base hypertrophy at preoperative drug-induced sedation endoscopy. The results of this procedure were compared with the coblation endoscopic lingual lightening (CELL) technique used to ablate (or minimally resect) the central part of the tongue base, in another 25 adult OSA patients with similar characteristics (age, sex, preoperative body mass index and Apnea-Hypopnea Index, AHI). The base of tongue surgery was part of multilevel surgery including also septoturbinoplasty and barbed reposition pharyngoplasty (with/without tonsillectomy).
In this study, the Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgical settings. No/minimal intraoperative or postoperative complications were observed. Postoperative pain as measured by visual analog scale ranged from 3 to 7. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by a level 3 polygraphy performed 6 months after surgery. There was significant difference in operative time at the level of the tongue base between Robo-Cob and CELL techniques, with shorter times observed within the Robo-Cob group. Moreover, the Robo-Cob technique provided tongue base tissue specimens that allowed measurement of the volume that ranged from 5 to 17 cm3 (mean 11.64 ± 3.49 cm3). It was found that resection of at least 10 cm3 of tongue base tissue was associated with better outcomes in terms of postoperative AHI reduction.
In this study, the added values of using coblation for resection and not ablation appear to be the short surgical time, the low postoperative tissue edema, and the possibility of providing tissue specimens to measure resected volumes.
本文描述了一种用于治疗打鼾和阻塞性睡眠呼吸暂停（OSA）的新型经口舌根外科手术。由于在某些国家，经口机器人手术（TORS）无法用于治疗此类良性疾病，因此该手术采用了等离子消融技术，因此被命名为“Robo-Cob”技术。
在这项前瞻性、随机、对照临床试验中，在 25 例术前药物诱导镇静内镜检查证实舌根肥大的 OSA 成年患者中进行了新的 Robo-Cob 手术。将该手术的结果与另 25 例具有相似特征（年龄、性别、术前体重指数和呼吸暂停低通气指数，AHI）的 OSA 成年患者中使用等离子消融内镜舌体减轻术（CELL）技术消融（或最小限度切除）舌根中央部分的结果进行比较。舌根手术是包括鼻中隔成形术和带刺复位咽成形术（伴/不伴扁桃体切除术）在内的多平面手术的一部分。
在这项研究中，Robo-Cob 技术在单独使用或与多平面手术中其他程序联合使用时，在所有病例中均被证明是可行且有效的。未观察到术中或术后并发症。术后疼痛采用视觉模拟量表（VAS）测量，范围为 3 至 7。任何患者均未行气管切开术。术后 6 个月行三级多导睡眠图检查，证实了临床客观改善。Robo-Cob 组和 CELL 组之间舌根的手术时间存在显著差异，Robo-Cob 组的手术时间更短。此外，Robo-Cob 技术提供了可测量体积的舌根组织标本，体积范围为 5 至 17cm3（平均 11.64 ± 3.49cm3）。发现切除至少 10cm3 的舌根组织与术后 AHI 降低的更好结果相关。
在本研究中，使用等离子消融进行切除而非消融的附加价值似乎在于手术时间短、术后组织水肿程度低以及提供可测量切除体积的组织标本的可能性。
