Two-Incision Approach for Hypoglossal Nerve Stimulator Placement: A Single Institution Assessment

Abstract

Objective(s): Upper airway stimulator (UAS) placement is a treatment for obstructive sleep apnea (OSA) with few complications and low morbidity. UAS placement has traditionally been performed using a three-incision approach, however, it has been implanted using a two-incision approach. This approach could significantly decrease operation time without a difference in postoperative complications, demonstrating its safety and feasibility for UAS placement. The objective was to assess operative time and complication rate in the two-incision approach for UAS placement compared to the three-incision approach. Study Design: Retrospectively reviewed. Methods: Patients who underwent UAS placement using the two- or three-incision approach at a single academic institution from November 2014 to June 2021 were retrospectively reviewed. The two-incision approach did not include the incision at the mid-axillary line. Main outcome measures included operation time and complication rates. Results: Three-hundred forty-eight patients underwent UAS placement. The three-incision approach demonstrated an average operation time of 143.3 minutes whereas the two-incision approach averaged 129.4 minutes (P.99), patient-reported discomfort (5.6% vs. 6.5%, P >.99), activity restriction (0% vs. 1.4%, P >.50), and incisional pain (0.0% vs. 1.0%, P >.99). No patients experienced incision site bleeding or infection. The two-incision approach was associated with decreased rate of revision surgery (0.0% vs. 5.4%, P =.048). Conclusion: The UAS two-incision approach proved to have a significantly shorter operative time without an increase in complications as compared to the three-incision approach. This approach is a safe and feasible option. Level of Evidence: 3 Laryngoscope, 132:1687–1691, 2022.