Menorah Medical Center
March 13, 2012

Richard Palmay used to take the notion of tossing and turning in bed to an entirely different level than most people during the course of a normal night’s sleep. Imagine waking up 79 times an hour—that’s once every 40 seconds—which is what Palmay did, night after night. The 48-year-old retired Kansas City firefighter couldn’t get a good night’s sleep to save his life, which is exactly why he began to seek relief in 2010. Chronically exhausted, Palmay decided to visit a physician after his wife, Mary, became alarmed with her husband’s breathing—or lack of—during sleep.

“Mary would wake up and realize I had momentarily stopped breathing,” says Palmay, who knew the lack of sleep was not only causing stress on his heart, but also adversely affecting his quality of life. “I was beyond exhausted.”

Palmay suffers from sleep apnea, a common disorder characterized by abnormal pauses in breathing or abnormally low breathing during sleep. In fact, David Rudman, MD, otolaryngologist or ENT specialist, of Head and Neck Surgical Associates, Inc. on the campus of Menorah Medical Center in Overland Park, calls sleep apnea a deadly and silent killer that plagues an estimated 11 to 18 million Americans. When Palmay came to his office in 2010, Doctor Rudman saw a man who defied the stereotypical sleep apnea patient—he was fit and trim. “One of the reasons we’re seeing an increase in the disorder is that so many people are overweight,” says Rudman. “Richard is five-feet-ten-inches and weighs 165 pounds.”

Doctor David Rudman MDDr. Rudman prescribed two nights in a sleep lab to verify Palmay’s constant sleep interruptions and after reviewing the results, recommended the use of a continuous positive airway pressure (CPAP) machine. Palmay used the machine at night, but experienced significant discomfort. During another consultation, Dr. Rudman recommended a multi-stage approach for Palmay, who had reached the end of his tolerance. “Something had to change,” says Palmay.

In 2010 Dr. Rudman first performed an uvulopalatoplasty on Palmay, which removed his uvula—the U-shaped piece of soft tissue that dangles from the palate over the back of the tongue. Then Dr. Rudman performed a functional rhinoplasty, which is a corrective surgical procedure to correct blockages of the nasal airway passages. The procedure could be compared to an internal use of the popular over-the-counter Breathe Right® nasal strips that help relieve nighttime congestion. The two procedures were able to help Palmay breathe better, reducing his tossing and turning, and improving his sleep apnea, but not enough to cure him of the disease. The next stage of Dr. Rudman’s approach to help Palmay’s sleep apnea was tongue-base reduction surgery, during which the physician elected to use the da Vinci Surgical Robot. Menorah Medical Center, part of HCA Midwest Health System—Kansas City’s largest healthcare network—acquired the da Vinci in November 2011. The advanced technology provides highly magnified visualization inside the body while offering a surgeon greater precision and can be used for a multitude of procedures including prostatectomy, hysterectomy, coronary artery bypass and colorectal surgery, among others.

Dr. Rudman is known for employing advanced technologies to improve patient outcomes and is one of Kansas City’s first otolaryngologists to receive rigorous training on the robotic surgical system. “I attended intensive training at the Hospital of the University of Pennsylvania, and I will use the da Vinci on patients with head, neck and throat tumors,” he says. “The da Vinci is frequently used in urologic and gynecologic procedures, and is just starting to be used in my field. I adopt new technologies when it has significant advantages for the patient.”

Dr. Rudman decided to use the da Vinci, which takes surgery beyond the limits of the human hand, at Menorah Medical Center on February 15, 2012, for Palmay’s tongue-base reduction surgery. It is the first surgery of its kind performed in Kansas City on the da Vinci.

“Tongue reduction is performed on certain patients with sleep apnea,” says Dr. Rudman. “It’s difficult to reduce the tongue far enough with traditional transoral approaches, but the da Vinci provides better access, is minimally invasive, has a quicker recovery time and fewer side effects.”

Palmay is optimistic that the surgery Dr. Rudman performed will help correct his sleep apnea. “It was a logical step for me when Dr. Rudman presented it,” says Palmay. “I didn’t think about it twice.”

Dr. Rudman says the future is here for complex, minimally invasive procedures with what just might be a surgeon’s best friend—the da Vinci robot. “We’ll continue to learn just how much this technology can impact patient outcomes,” says Dr. Rudman. “It’s an exciting time.”