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Robots to the Rescue: Penn Medicine Pioneers New Way to Treat Obstructive Sleep Apnea

Can sleeping actually make you MORE tired? For many patients with obstructive sleep apnea (OSA), they awake each morning thinking they had a full night’s rest, only to feel exhausted and unfocused day after day. This counterintuitive situation occurs because OSA sufferers may wake up dozens of times an hour or more each night without even realizing it due to pauses in breathing that can jolt a person out of sleep. The staggered breathing is the direct result of the airway collapsing or becoming blocked during sleep.

That was the case for Penn Medicine patient Daniel Sheiner. At 32, his exhaustion was starting to become an issue while he was at work. He would wake up each morning believing he had slept through the night, but never actually felt any of the restorative benefits. After seeking medical help and undergoing a sleep exam, doctors determined that he had a very severe case of OSA. After many failed attempts with standard front line therapies such as lifestyle changes, mouthpieces, and breathing devices, Daniel learned about a new surgical approach for OSA being pioneered at Penn Medicine.

Doctors in Penn’s Department of Otorhinolaryngology: Head and Neck Surgery are now building upon the surgical expertise gained through earlier pioneering work in robotic head and neck surgery and their development of the procedure called TransOral Robotic Surgery (TORS) for tongue base cancers to address the tongue base component of OSA. Specifically, they are identifying surgical candidates, such as Daniel, who have tongue base level obstruction causing sleep apnea, and applying the TORS procedure to correct the obstruction.

Developed by Bert W. O'Malley Jr., MD,  and Gregory S. Weinstein, MD, TORS was originally developed for a variety of robotic surgical neck approaches for both malignant and benign tumors of the mouth, voice box, tonsil, tongue and other parts of the throat. TORS has dramatically improved the way head and neck cancer patients are treated, completely removing tumors while preserving speech, swallowing, and other key quality of life issues. With the great success of TORS for head and neck cancers, Penn doctors began to explore other uses for the robotic surgical approach, including OSA.

Traditional surgery for sleep apnea removes the tonsils, uvula and part of the soft palate, but can’t reach deep areas at the base of the tongue, that in some people, causes the blockage while they sleep. Previous surgical techniques for OSA were also less precise and potentially less effective because the surgeon was only able to use one hand, and had limited maneuverability in the tight spaces of the mouth and throat. The robotic-assisted, minimally invasive procedure offers the surgeon improved visualization and the ability to move tiny surgical instruments in tight, hard-to-reach places and get at the area at the base of the tongue.

"What the robot allows you to do is get into a small, confined space without using hands," says Erica Thaler, MD, professor of Otorhinolaryngology: Head and Neck Surgery, who is leading the ongoing research into this new approach at Penn. "Human hands are huge, and robot hands are tiny, and yet they can do exactly the same thing if you control them remotely. It's basically opened up a whole new area of surgery that wasn't doable before.”

Dr. Thaler

Dr. Erica Thaler in the TORS surgical suite at Penn Medicine

A recent study by Drs. Thaler, O’Malley, Weinstein and other colleagues at Penn found that the TORS approach achieved a significant reduction in the apnea-hypopnea index (AHI) (an index used to assess the severity of sleep apnea), a significant improvement in minimum arterial oxygen saturation (the amount of oxygen in your blood that maintains healthy organ functioning), and a significant improvement in daytime drowsiness in patients.

For Daniel, the TORS approach proved to be a true robotic rescue. After the surgery, he says, "it was a whole new life."  With new found energy from truly getting a full night’s rest, he is taking Latin and ballroom dance lessons six days a week.  “That's something I wanted to do for many, many years prior to the surgery, but had neither the energy nor the self-confidence to try.  The normal sleep made possible by the surgery gave me both.”

Hear Daniel tell his story in this NPR interview “How To Beat Sleep Apnea? Cut It Out (Surgically)” and watch the procedure in this 6ABC interview with Dr. Thaler “Surgical robot is the latest tool for sleep apnea.

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