Author(s)
Ahmed Y. Bahgat, MD, EBE-ORL
Yassin Bahgat
Rajab Alzahrani
Abdulmohsen Alterki
Affiliation(s)
Alexandria University Medical School;
Abstract:
Objective: This study aimed to assess the feasibility, efficacy, and safety of using coblation technology with barbed sutures to perform multilevel sleep surgery in obese (BMI 30-35) patients with moderate to severe OSA (AHI>15).
Study Design: prospective cohort study.
Setting: Multicenter study at ENT departments of Egypt, Kuwait, and Saudi Arabia.
Methods: Forty adults obese OSA patients with a mean age of 42.8 ± 8.5 years with a mean BMI of 32.88 ± 1.69 kg/m2 underwent coblation multilevel surgery. Coblation was used in tonsillectomy, palatopharyngeal muscle sectioning at its lower part with instant hemostasis, and ablation of supratonsillar fat then inserting the V-Loc™ wound closure device in the soft palate similar to original BRP. Then Coblation was used to resect tongue base with a similar technique as described in TORS. In the end, nasal surgery was done without putting in nasal packs.
Results: Coblation multilevel surgery is proved to be fast (mean operative time 95.8 ± 10.27 minutes), minimally invasive (<100 ml blood loss and VAS for pain 4 ± 1.22). Objective clinical improvement was confirmed by polygraphy 3 months post-operatively with a significant decrease in mean AHI from 34.24 ± 10.26 to 14.12 ± 7.56 (P<0.005). No significant complications were reported. No tracheostomy was carried out in any patient.
Conclusion: The use of coblation in a Multilevel surgery setting in obese patients with moderate to severe OSA is proved to be feasible, effective in lowering AHI, and safe without major complications.