Trans Oral Robotic Surgery (TORS) – a contemporary cure for sleep apnea

People don’t pay attention to snoring unless it disrupts sleep of their partners or of themselves for that matter.

Snoring can happen due to innumerable reasons, most of which are treatable. Knowing about your condition is the first step in treating it.

Sleep apnea is a condition which affects your breathing when you are asleep causing it to get interrupted or very shallow. This leads to chronic sleep deprivation as well as a host of other health problems. One major type of sleep apnea is OSA.

woman sleeping on a pillow
Woman sleeping on a pillow; image source:

What is OSA or Obstructive Sleep Apnoea?

Obstructive sleep apnea or more commonly snoring is a common medical condition which affects as much as 15-50% of adults in the world. As one of the most under-diagnosed conditions worldwide, it can have a grave impact on your health if left untreated for long.

Snoring is caused due to the vibration of the tissues in your throat, which could be a result of various factors.

From sleeping on your back to excess alcohol or sleeping pill consumption, snoring has several causes. Even a partial block can lead to complete airway obstruction, which in medical terms is called obstructive sleep apnea or OSA. About 28 million people are believed to be affected with this disorder. This can cause a person to stop breathing for a couple of minutes during sleep.

So how can you figure out whether your night time snoring is due to OSA or just an improper sleeping posture? Some of the indications for OSA include:
Excessive sleepiness during the day and feeling of exhaustion and low performance.

  • Dry mouth on waking up.
  • Headaches during the morning.
  • Night sweats.
  • Irritability, depression, forgetfulness and trouble in concentration.
  • Tendency to wake up in the middle of the night gasping for air.
  • Snoring.
  • Sleep restlessness.
  • Sexual dysfunctions.

The risk factors associated with developing this condition are given as:

  • Being overweight.
  • Smoking.
  • Related to someone suffering from sleep apnea.
  • Over the age of 65.

When is surgical treatment considered?

People suffering from sleep apnea or specifically OSA are treated with positive airway pressure technique. This method of treatment is extremely common, safe as well as effective in majority of the cases.

This technique involves making patients wear a mask during their sleep, which forces the airway open, hence enabling smoother and uninterrupted breathing.

Other conservative techniques to prevent snoring include:

  • Losing weight, since excess weight leads to extra tissues at the back of the throat which can block the airway.
  • Avoiding alcohol, sleeping pills, and sedatives as well as smoking: they relax your throat muscles hence increasing your tendency to smoke.
  • Using nasal strips: they help open up your nasal passages too, promoting better sleep.
  • Sleeping on your side rather than on your back.

In some cases however, patients are not able to tolerate using a mask at night, either due to irritation or discomfort. In case all other conservative techniques fail, the only other option to treat sleep apnea is surgery. Not only is it permanent, but also effective.

Here is where TORS or Trans Oral Robotic Surgery comes into the picture, as one of the recent techniques used to combat snoring.

What is Trans Oral Robotic Surgery (TORS)?

This procedure was developed in 2004 at the Head and Neck surgery hospital at the University of Pennsylvania by the department of Otorhinolaryngology. It was originally intended to treat tumors of the neck and head.

In 2009, the FDA cleared the Da Vinci Surgical System for TransOral otolaryngologic surgical procedures. Initially it was used only to treat tumors, but it is now being used for treating sleep apnea as well. Here the surgeon will have superior access and view of the patient’s tongue and mouth.

What are the conditions during which TORS is performed?

The surgery is basically for those patients whose sleep apnea is caused by obstruction due to the tongue. The initial process involves an assessment of the patients which includes recent sleep study reviews and identification of amount of tissue obstruction.

What is the procedure for TORS?

Initially, the patients are examined to determine whether they can be TORS candidates. This involves a sleep study, a neck MRI and a sleep endoscopy to find the tissue obstruction level. The TORS surgeon uses devices to control the surgical instruments, by watching from a 3D view of the surgical area. The entire procedure requires extreme precision and accuracy and allows operation in small areas of the mouth and throat.

Post the surgery, patients require a hospital stay of at least 2 days. The total time required for complete recovery is about three weeks. Full recovery is expected to take about three weeks. A sleep study is usually conducted about three months after surgery to ensure that the procedure was successful.

What is the benefit of TORS?

TORS is better than traditional surgery since it reduces the stigma associated with open surgery, namely scars and disfigurement. The other additional advantages include:

  • Less pain, scarring as well as lesser risk of infection.
  • Shorter recovery time.
  • Extremely accurate hence allows surgery of areas otherwise unreachable.
  • Filters out hand tremors.



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