Trans Oral Robotic Functional Expansion Pharyngoplasty (TORFEP) with Unidirectional Barbed Sutures

Background: Collapse of the lateral pharyngeal wall (LPW) in the pathogenesis of OSA appears to be the only independent risk factor for OSA. Therefore, since 2003, when Cahali first published the technique of lateral pharyngoplasty, several surgical techniques targeting the LPW have been described. Central to these is the concept of widening and stabilizing the pharyngeal airspace by treating the collapse of the LPW rather than removing the redundant pharyngeal soft tissue. The advent of robotic surgery has led to the development of new techniques in OSA surgery, the main target of which is the base of the tongue. Pharyngoplasty using robotic technology can be beneficial when this procedure is combined with tongue base reduction, which is known to be best performed with robotic surgery. Methods: This article presents a new technique for functional expansion pharyngoplasty (FEP), which is a modification of the functional expansion pharyngoplasty previously described by Sorrenti and Piccin and is performed using robotic surgery with a Da Vinci system. Results and Conclusions: Transoral robotic functional expansion pharyngoplasty is an effective, standardizable technique for treating OSA, notable for its ease of learning and performing.