Robotic-assisted surgery for the management of velopharyngeal insufficiency and nasopharyngeal stenosis

n the last few years, surgery has proved to be a valuable alternative for the obstructive sleep apnoea–hypopnoea syndrome (OSAHS) in cases of continuous positive airway pressure (CPAP) failure. However, OSAHS surgical procedures are not complication free[1]. Nasopharyngeal stenosis (NPS) and velopharyngeal insufficiency (VPI) are the most difficult complications to manage. A superb 3D endoscopic-magnified view associated with a precise tissue manipulation is considered the main advantages of transoral robotic surgery (TORS). We revisited and adapted for robotic surgery two classic surgical techniques. In case of NPS, we developed a one-step stent-less procedure largely inspired by the so-called bivalved palatal transposition flaps[2] and a technique for glottic web[3]. Herein, we will describe this technique as robotically assisted bivalved palatal transposition flaps (RA-BPTF). In case of VPI, we applied a modification of the so-called Pharyngeal Flap[4] describing this technique as robotically assisted pharyngeal flap (RA-PF).