For the more than 18 million Americans whose sleep is disrupted by sleep apnea, which is characterized by abnormal pauses in breathing, a good night’s sleep … let alone a dream … is simply out of the question.

Obstructive sleep apnea, the most common category of sleep-disordered breathing, is caused by the relaxation of the collapsible walls of the soft tissue of the throat, resulting in abnormal pauses in breathing or instances of abnormally low breathing during sleep. Each pause, or apnea, can stretch from a just few seconds to minutes and may occur as much as 30 or more times an hour.

Chronic obstructive sleep apnea can have significant consequences. Typically, the condition worsens with age as the muscles at the back of the throat lose their tone and strength. Individuals with low muscle tone, soft tissue around the airway and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea.

Standard treatment for sleep apnea is a continuous positive airway pressure device (CPAP), although many patients are unable to tolerate sleeping with the device or long for a “normal night’s sleep” without wearing it. Surgery, most commonly uvulopalatopharyngoplasty (UPPP), is another option but comes with traditional surgical risks and mixed results. Rarely are success rates higher than 65 percent for most sleep apnea patients who undergo UPPP.

Enter Murfreesboro otolaryngologist, William E. Gross, MD, who has had recent success with a new procedure to correct the causes of sleep apnea using the da Vinci Robotic Surgical System to perform TransOral Robotic Surgery (TORS) procedures.

Gross said, “The robotic technology allows the surgeon to visualize and operate in the spaces in the throat that otherwise would not be accessible.”

The da Vinci system offers the surgeon “adequate exposure” for transoral resection of hypertrophic lingual tonsils in patients with obstructive sleep apnea. The manual image-guided surgery system is computer enhanced rather than computer guided robotic surgery. Gross, the first physician in Tennessee and one of the first in the nation to perform the TORS procedure, realized that the da Vinci system exactly translates the surgeon’s hand and finger movements at the console for precise, tremor-free movements.

“I had been operating for a couple of years on primary cancers in the back of the tongue, and when I became aware of the capabilities of the da Vinci system, I thought it looked like a good procedure for that type of surgery, as well as an application for treating sleep apnea,” he recalled. The FDA agreed, granting approval for TORS at the end of 2009.

“Two of my patients had previously tried surgery, but the results were unsuccessful,” said Gross, who has practiced in Murfreesboro since 2003.

Initial reports from Europe indicate an 80 to 90 percent success rate in treating sleep apnea with the robotic system as opposed to the 40 to 50 percent rate of the traditional surgery.

The procedure involves removing overgrown tissue on the back of the tongue and takes about 45 minutes. Following surgery, patients have reported mild-to-moderate pain, no difficulty swallowing and the ability to sleep without a breathing device the first night after the procedure.

Gross observed, “Recovery time in terms of pain and swelling is greatly reduced and post operative sleep studies have determined a level of success.”

A Memphis native, Gross graduated from Rhodes College before entering the University of Virginia School of Medicine in Charlottesville. He graduated in the top 10 percent of his class and was named to Alpha Omega Alpha Honor Medical Society and Phi Beta Kappa. 

He served on the faculty at UVA as an assistant professor of Otolaryngology and interned at Methodist Hospital of Memphis before completing his residency at Ohio State University. Gross is certified by the American Board of Otolaryngology in Head and Neck Surgery. He now practices at the Murfreesboro Medical Clinic and is on the staff at Middle Tennessee Medical Center.

His enthusiasm for the application of robotic procedures has spread to other departments at MTMC, which is one of the few hospitals where the da Vinci equipment is fully integrated in the surgical departments of the hospital including urology, gynecologic, and bariatric surgery, as well as otolaryngology.

Gross is married and has a nine-year-old and a one-year-old.  The family lives on a “hobby farm” with horses, goats and a fruit orchard. He enjoys golf and tennis when he can find time to get in a match.

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