Transoral Robotic Surgery For Obstructive Sleep Apnea

This comprehensive book pulls together the essential elements needed to assess sleep apnea patients for the transoral robotic surgical approach and how to optimize the surgery. Detailed information on patient selection, pre-operative work up, anesthesiological pre and post-operative management, surgery, complication prevention and management is provided along with background on sleep medicine and sleep surgery. Authored for ENT surgeons, head and neck specialists and neurologists, pneumonologists, sleep doctors as well for anesthesiologists, chapters offer solutions pulled from experts in the field of sleep surgery and information relevant to geographic areas worldwide.

Finally, a multi-disciplinary approach that covers both the surgical and non-surgical interventions for sleep apnea and snoring. From the editor of Operative Techniques in Otolaryngology, this new reference will quickly become the standard in surgery for this key area within otolaryngology. ., Full-color line drawings illustrate key concepts and create a comprehensive way of learning surgical techniques. Provides consistent, templated chapters and a contemporary, full-color format for quick, easy access to the most up-to-date surgical and non surgical interventions for sleep apnea and snoring. Includes contributions from leaders in neurology, pulmonology, psychiatry, otolaryngology, and oral & maxillofacial surgery. to create a truly multi-disciplinary approach. Covers new and innovative procedures including ZPP (Zeta palatopharyngoplasty), Transpalatal Advancement Pharyngoplasty and Minimally invasive submucosal glossectomy Details when and why surgery is necessary, and how to perform a successful operation for snoring and sleep apnea.

The definitive resource on the innovative use of DISE for obstructive sleep apnea Obstructive sleep apnea is the most prevalent sleep-related breathing disorder, impacting an estimated 1.36 billion people worldwide. In the past, OSA was almost exclusively treated with Continuous Positive Airway Pressure (CPAP), however, dynamic assessment of upper airway obstruction with Drug-Induced Sleep Endoscopy (DISE) has been instrumental in developing efficacious alternatives. Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications by Nico de Vries, Ottavio Piccin, Olivier Vanderveken, and Claudio Vicini is the first textbook on DISE written by world-renowned sleep medicine pioneers. Twenty-four chapters feature contributions from an impressive group of multidisciplinary international experts. Foundational chapters encompass indications, contraindications, informed consent, organization and logistics, patient preparation, and drugs used in DISE. Subsequent chapters focus on treatment outcomes, the role of DISE in therapeutic decision making and upper airway stimulation, pediatric sleep endoscopy, craniofacial syndromes, advanced techniques, and more. Key Highlights Comprehensive video library highlights common and rare DISE findings A full spectrum of sleep disordered breathing and OSA topics, from historic to future perspectives Insightful clinical pearls on preventing errors and managing complications including concentric and epiglottis collapse Discussion of controversial DISE applications including oral appliances and positional and combination therapies This unique book is essential reading for otolaryngology residents, fellows, and surgeons. Clinicians in other specialties involved in sleep medicine will also benefit from this reference, including pulmonologists, neurologists, neurophysiologists, maxillofacial surgeons, and anesthesiologists.

Anesthesia for Otolaryngologic Surgery offers a comprehensive synopsis of the anesthetic management options for otolaryngologic and bronchoscopic procedures. Authored by world authorities in the fields of anesthesiology and otolaryngology, both theoretical concepts and practical issues are addressed in detail, providing literature-based evidence wherever available and offering expert clinical opinion where rigorous scientific evidence is lacking. A full chapter is dedicated to every common surgical ENT procedure, as well as less common procedures such as face transplantation. Clinical chapters are enriched with case descriptions, making the text applicable to everyday practice. Chapters are also enhanced by numerous illustrations and recommended anesthetic management plans, as well as hints and tips that draw on the authors' extensive experience. Comprehensively reviewing the whole field, Anesthesia for Otolaryngologic Surgery is an invaluable resource for every clinician involved in the care of ENT surgical patients, including anesthesiologists, otolaryngologists and pulmonologists.

BackgroundA 55 year old man with severe Obstructive Sleep Apnoea (OSA) underwent transoral robotic midline glossectomy and epiglottic wedge resection, after failing Continuous Positive Airway Pressure (CPAP) therapy. MethodAfter assessment with Drug Induced Sleep Endoscopy (DISE), it was found that the patient still had significant level 3 obstruction. A simple mouth closure opened the airway significantly during the procedureResultsThe patient was recommended a chin strap as treatment for his persistent OSA. Repeat sleep study with the chin strap on showed a reduction of AHI from 35/hour to 5/hour.ConclusionsThis case demonstrates the importance of performing DISE in patients who have persistent OSA after surgery. It also highlights the effectiveness of simple devices such as chin straps, in the treatment of OSA.

There are at least four reasons why a sleep clinician should be familiar with rating scales that evaluate different facets of sleep. First, the use of scales facilitates a quick and accurate assessment of a complex clinical problem. In three or four minutes (the time to review ten standard scales), a clinician can come to a broad understanding of the patient in question. For example, a selection of scales might indicate that an individual is sleepy but not fatigued; lacking alertness with no insomnia; presenting with no symptoms of narcolepsy or restless legs but showing clear features of apnea; exhibiting depression and a history of significant alcohol problems. This information can be used to direct the consultation to those issues perceived as most relevant, and can even provide a springboard for explaining the benefits of certain treatment approaches or the potential corollaries of allowing the status quo to continue. Second, rating scales can provide a clinician with an enhanced vocabulary or language, improving his or her understanding of each patient. In the case of the sleep specialist, a scale can help him to distinguish fatigue from sleepiness in a patient, or elucidate the differences between sleepiness and alertness (which is not merely the inverse of the former). Sleep scales are developed by researchers and clinicians who have spent years in their field, carefully honing their preferred methods for assessing certain brain states or characteristic features of a condition. Thus, scales provide clinicians with a repertoire of questions, allowing them to draw upon the extensive experience of their colleagues when attempting to tease apart nuanced problems. Third, some scales are helpful for tracking a patient’s progress. A particular patient may not remember how alert he felt on a series of different stimulant medications. Scale assessments administered periodically over the course of treatment provide an objective record of the intervention, allowing the clinician to examine and possibly reassess her approach to the patient. Finally, for individuals conducting a double-blind crossover trial or a straightforward clinical practice audit, those who are interested in research will find that their own clinics become a source of great discovery. Scales provide standardized measures that allow colleagues across cities and countries to coordinate their practices. They enable the replication of previous studies and facilitate the organization and dissemination of new research in a way that is accessible and rapid. As the emphasis placed on evidence-based care grows, a clinician’s ability to assess his or her own practice and its relation to the wider medical community becomes invaluable. Scales make this kind of standardization possible, just as they enable the research efforts that help to formulate those standards. The majority of Rating Scales in Sleep and Sleep Disorders:100 Scales for Clinical Practice is devoted to briefly discussing individual scales. When possible, an example of the scale is provided so that readers may gain a sense of the instrument’s content. Groundbreaking and the first of its kind to conceptualize and organize the essential scales used in sleep medicine, Rating Scales in Sleep and Sleep Disorders:100 Scales for Clinical Practice is an invaluable resource for all clinicians and researchers interested in sleep disorders.

Flexible Robotics in Medicine: A Design Journey of Motion Generation Mechanisms and Biorobotic System Development provides a resource of knowledge and successful prototypes regarding flexible robots in medicine. With specialists in the medical field increasingly utilizing robotics in medical procedures, it is vital to improve current knowledge regarding technologies available. This book covers the background, medical requirements, biomedical engineering principles, and new research on soft robots, including general flexible robotic systems, design specifications, design rationale, fabrication, verification experiments, actuators and sensors in flexible medical robotic systems. Presenting several projects as examples, the authors also discuss the pipeline to develop a medical robotic system, including important milestones such as involved regulations, device classifications and medical standards. Covers realistic prototypes, experimental protocols and design procedures for engineering flexible medical robotics Covers the full product development pipeline for engineering new flexible robots for medical applications, including design principles and design verifications Includes detailed information for application and development of several types of robots, including Handheld Concentric-Tube Flexible Robot for Intraocular Procedures, a Preliminary Robotic Surgery Platform with Multiple Section Tendon-Driven Mechanism, a Flexible Drill for Minimally Invasive Transoral Surgical Robotic System, Four-Tendon-Driven Flexible Manipulators, Slim Single-port Surgical Manipulator with Spring Backbones and Catheter-size Channels, and much more