Obstructive Sleep Apnea, Snoring
Conditions
Keywords
Vessel sealing system, uvulopalatoplasty, UPPP, uvulopalatal flap, bleeding, operative time, adverse effects
Brief summary
The purpose of this study is to compare vessel sealing system uvulopalatoplasty (VSSU) to the traditional uvulopalatal flap (UPF) in the treatment of sleep-disordered breathing with special regard to intraoperative bleeding, operative time, postoperative pain, postoperative hemorrhage and other adverse effects.
Detailed description
Uvulopalatopharyngoplasty is one of the common procedures performed by otolaryngologists to treat sleep-disordered breathing patients who have retropalatal obstruction. Intraoperative bleeding is a significant problem which requires hemostasis and causes prolonged operative time. Several different techniques are used to perform this operation, including cold knife, monopolar cautery, coblation, and radiofrequency. Efficacy in hemostasis and tissue trauma from different operative techniques may result in different operative time and different degrees of morbidity including intraoperative blood loss, postoperative pain, postoperative hemorrhage, and velopharyngeal insufficiency (VPI). The vessel sealing system has been widely used in head and neck surgery because of its effectiveness and safety. It was also found quite effective and safe in tonsillectomy procedures, providing excellent hemostasis and minimal tissue trauma.
Interventions
PROCEDUREVessel sealing system uvulopalatoplasty (VSSU)
Vessel sealing system uvulopalatoplasty (VSSU) is a new technique for uvulopalatoplasty using a special biclamp forceps for better hemostasis control. Vessel sealing system (VSS) is a bipolar vascular sealing system, with integrated active feedback control. The tissue is grasped and compressed by the handpiece. After the instrument is removed, the seal is visible as a semitransparent window, which can safely be divided. Uvular tip is grasped with an Allis clamp and retracted back toward the soft palate. Excision of the uvula and the redundant part of soft palate is performed by the VSS handpiece. VSS is also used for hemostasis.
PROCEDUREUvulopalatal flap (UPF)
Uvulopalatal flap (UPF) is a standard uvulopalatoplasty technique. Uvulopalatal flap is usually performed as described originally by Powell et al. The soft palate was injected with 5 to 10 milliliters of 1% lidocaine with epinephrine solution. The mucosa, submucosa with glands, and fat on the lingual surface of the uvula and soft palate were removed with a scalpel. Bleeding was controlled with bipolar electrocoagulation. The uvular tip was amputated, and reflected back toward the soft palate, and fixated into its new position with multiple sutures of 3-0 chromic catgut.
Sponsors
Chulalongkorn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patient planned for uvulopalatoplasty for indications of snoring or obstructive sleep apnea * Written informed consent form is given from patient
Exclusion criteria
* Pregnancy * History of bleeding disorders * Patient unable to understand evaluation method * Patient unable to be contacted via telephone
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| intraoperative blood loss | within the first 1 hour after surgery starting time |
Secondary
| Measure | Time frame |
|---|---|
| operative time | within the first 1 hour after surgery starting time |
| postoperative pain | within the first 14 days after surgery |
| postoperative bleeding | within the first 14 days after surgery |
| postoperative velopharyngeal insufficiency | within the first 3 months after surgery |
Countries
Thailand
Outcome results
None listed