Two-Incision Approach a Safe, Feasible Option for Upper Airway Stimulator Placement for Obstructive Sleep Apnea

by Linda Kossoff •

How does a two-incision approach compare with a three-incision approach in safety and feasibility when performing upper airway stimulator (UAS) placement as a treatment for obstructive sleep apnea (OSA)?

BOTTOM LINE

The UAS two-incision approach is a safe and feasible option when performing UAS placement as a treatment for OSA.

BACKGROUND: UA stimulation is a treatment used to address OSA by electrically stimulating select levels of the hypoglossal nerve to induce contraction of the genioglossus muscle and enlarge airways. Traditionally, the UAS implant has been placed using a three-incision approach, although a two-incision approach has also been used.

STUDY DESIGN: Retrospective review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa.

SYNOPSIS: Researchers identified 348 patients (average body mass index [BMI] 28.7) who underwent UAS using the three-incision approach (79.3%) or the two-incision approach (20.7%) at a single academic institution from November 2014 to June 2021. The two-incision approach did not include the incision at the mid-axillary line. Main outcome measures included operation time and complication rates. The majority (95.1%) of patients were discharged the same day as their surgery. For the three- and two-incision approaches, 16 (5.8%) patients and 1 (1.4%) patient stayed for a single night hospital admission, respectively. The average operation time was 143.3 minutes for the three-incision approach and 129.4 minutes for the two-incision approach. This finding of a shorter operative time for the two-incision approach was maintained when corrected for age, gender, and BMI. Researchers did not see an increase in postoperative complications rates with the two-incision approach. Study limitations included its retrospective nature, reliance on clinic notes to record postoperative complications, and the fact that the two-incision approach is newer, precluding the same follow-up time frame as many three-incision approach surgeries.

CITATION: Sagalow ES, Rodin J, Estephan L, et al. Two-incision approach for hypoglossal nerve stimulator placement: a single institution assessment. Laryngoscope. 2022;132:1687–1691.