{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:16:24Z","timestamp":1760148984138,"version":"build-2065373602"},"reference-count":8,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T00:00:00Z","timestamp":1687305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway, leading to reduced or absent breathing during sleep. A nocturnal upper airway collapse is often multi-levelled. The aim of this communication is to describe a 3D multi-level surgery setting in OSA pathology, introducing new surgical approaches, such as 4K-3D endoscopic visualization for the tongue base approach with the aid of a coblator and exoscopic visualization in the palatal approach. (2) Methods: Seven patients affected by OSA underwent 3D Barbed Reposition Pharyngoplasty (BRP) surgery associated with transoral coblation tongue base reduction and nose surgery. (3) Results: No patients experienced intra-operative, post-operative or delayed complications. For OSA multi-level 3D surgery, it took less than 2 h: the median 3D system setting time was 12.5 \u00b1 2.3 min; the overall procedure time was 59.3 \u00b1 26 min. (4) Conclusions: The use of the 4K-3D endoscope and coblator for tongue base resectioning and of the 3D exoscope for lateral pharyngoplasty represents an excellent system in multi-level OSA related surgery that could reduce the time and the costs compared to those of robotic surgery.<\/jats:p>","DOI":"10.3390\/jcm12134173","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T02:01:33Z","timestamp":1687312893000},"page":"4173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Multi-Level 3D Surgery for Obstructive Sleep Apnea: Could It Be the Future?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3026-2082","authenticated-orcid":false,"given":"Angelo","family":"Eplite","sequence":"first","affiliation":[{"name":"Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d, University of Milan, Via GB Grassi 74, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Vicini","sequence":"additional","affiliation":[{"name":"Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Meccariello","sequence":"additional","affiliation":[{"name":"Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giannicola","family":"Iannella","sequence":"additional","affiliation":[{"name":"Department of \u2018Organi di Senso\u2019, University \u201cSapienza\u201d, Viale dell\u2019Universit\u00e0 33, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1251-0185","authenticated-orcid":false,"given":"Antonino","family":"Maniaci","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, ENT Section, University of Catania, Piazza Universit\u00e0 2, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-2549","authenticated-orcid":false,"given":"Angelo","family":"Cannavicci","sequence":"additional","affiliation":[{"name":"Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Moretti","sequence":"additional","affiliation":[{"name":"Department ENT & Audiology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Facchini","sequence":"additional","affiliation":[{"name":"Department ENT & Audiology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Mazzocco","sequence":"additional","affiliation":[{"name":"Department ENT & Audiology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1618-0048","authenticated-orcid":false,"given":"Giovanni","family":"Cammaroto","sequence":"additional","affiliation":[{"name":"Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Iannella, G., Magliulo, G., Greco, A., de Vincentiis, M., Ralli, M., Maniaci, A., Pace, A., and Vicini, C. (2022). Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19042459"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.otc.2014.03.004","article-title":"Transoral robotic sleep surgery: The obstructive sleep apnea-hypopnea syndrome","volume":"47","author":"Crawford","year":"2014","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.wjorl.2017.05.003","article-title":"Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique","volume":"3","author":"Vicini","year":"2017","journal-title":"World J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"214","DOI":"10.14639\/0392-100X-1203","article-title":"Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea","volume":"37","author":"Vicini","year":"2017","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.1097\/SCS.0000000000006875","article-title":"VITOM 3D System in Parotid Gland Surgery: Our Experience","volume":"32","author":"Mincione","year":"2021","journal-title":"J. Craniofac. Surg."},{"key":"ref_6","first-page":"e12694","article-title":"VITOM 4K 3D Exoscope: A Preliminary Experience in Thyroid Surgery","volume":"13","author":"Kullar","year":"2021","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1017\/S002221512100431X","article-title":"A three-dimensional exoscope system for bilateral simultaneous cochlear implant surgery: How I do it","volume":"136","author":"Tan","year":"2022","journal-title":"J. Laryngol. Otol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S103","DOI":"10.1016\/j.jmig.2015.08.278","article-title":"Initial Gynecologic Experience Using the VITOM\u00ae HD Exoscope for Vaginal Surgery","volume":"22","author":"Taylor","year":"2015","journal-title":"J. Minim. Invasive Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4173\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:57:38Z","timestamp":1760126258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,21]]},"references-count":8,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12134173"],"URL":"https:\/\/doi.org\/10.3390\/jcm12134173","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,6,21]]}}}