Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique

Abstract

Objective: The present study is a review of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods: The review presents the experience of the robotic center that developed the technique with regards to patient selection, surgical method, and post-operative care. In addition, the review provides results of a systematic review and meta-analysis of the complications and clinical outcomes of TORS when applied in the management of OSAHS.

Results: The rate of success, defined as 50% reduction of pre-operative AHI and an overall AHI <20 events/h, is achieved in up to 76.6% of patients with a range between 53.8% and 83.3%. The safety of this approach is reasonable as the main complication (bleeding) affected 4.2% of patients (range 4.2%-5.3%). However, transient dysphagia (7.2%; range 5%-14%) does compromise the quality of life and must be discussed with patients preoperatively.

Conclusions: TORS for the treatment of OSAHS appears to be a promising and safe procedure for patients seeking an alternative to traditional therapy. Appropriate patient selection remains an important consideration for successful implementation of this novel surgical approach requiring further research.

Keywords: Midline glossectomy; Obstructive sleep apnea; Partial glossectomy; Posterior glossectomy; Sleep surgery; TORS; Transoral robotic surgery.

Fig. 1

Patient perceived swallowing difficulty as measured before and after TORS for OSAHS (n = 78). Lower score indicates less swallowing difficulty.

Fig. 2

Findings on video fluoroscopic swallow study in patients with dysphagia following TORS for OSAHS (n = 80).

Fig. 3

Systematic review of the rates and types of complications commonly observed after TORS for OSAHS.

Fig. 4

Meta-analysis of clinical outcomes following TORS for OSAHS (n = 243).