Standalone Transoral Robotic Surgery for Obstructive Sleep Apnoea: A Systematic Literature Review of Clinical Outcomes

TL;DR

This review examines the effectiveness of robotic surgery for sleep apnea when used alone, finding it can improve sleep and symptoms in selected patients.

Contribution

The study provides a focused analysis of standalone robotic surgery outcomes for sleep apnea, distinct from combined procedures.

Findings

Combined mean AHI improved from 34.2 to 14.7 events/hour post-surgery.

Surgical success rates ranged from 54.2% to 100%.

Common complications included dysgeusia, dysphagia, and postoperative bleeding.

Abstract

Transoral robotic surgery (TORS) offers a targeted surgical option for addressing base of tongue (BOT) and epiglottic obstruction in selected obstructive sleep apnoea (OSA) cases; however, most published evidence evaluates TORS within multilevel approaches, limiting understanding of single-level outcomes. A PRISMA-guided systematic review of PubMed, Embase, and Central Cochrane was conducted from inception to March 2025, aiming to evaluate objective sleep outcomes and patient-reported measures following single-level TORS BOT surgery. Inclusion criteria were adult patients with moderate-to-severe OSA and CPAP failure/intolerance, with evidence of BOT hypertrophy. Of 219 screened records, five studies met the inclusion criteria with 105 patients. Eighty-six (81.9%) were male with a combined mean age of 45.2 years and BMI of 28.2 kg/m2. Combined mean AHI improved from 34.2 preoperatively to 14.7 events/hour postoperatively. Reported surgical success ranged from 54.2% to 100%. Where reported, ESS improved postoperatively with a combined mean reduction from 13 to 4.5. Most commonly reported complications were dysgeusia (n = 16, 15.2%), dysphagia/odynophagia (n = 14, 13.3%), and postoperative bleeding (n = 10, 9.5%). Single-level TORS BOT appears to improve objective and subjective outcomes in carefully selected patients, although heterogeneity and inconsistency of reported outcomes limit definitive conclusions and highlight the need for standardised outcome reporting and follow-up.

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