State of the art transoral robotic surgery for obstructive sleep apnea-hypopnea syndrome

To review the existing literature on the role of transoral robotic surgery (TORS) for tongue base reduction in the management of adult obstructive sleep apnea-hypopnea syndrome (OSAHS).

We searched PubMed, MEDLINE, and Scopus databases from the first literature report of this surgical technique to July 30, 2015 for studies investigating the use of TORS for tongue base reduction in treating adult OSAHS. Our primary outcome measures were Apnea- Hypopnea Index (AHI), lowest oxygen saturation (LSAT), Epworth Sleepiness Score (ESS), and the rates of surgical cure (AHI<5) and success (50% reduction in AHI accompanied by a postoperative AHI<20). Our secondary outcome measures were the volume of tissue resected and correlation to AHI, polysomnographic parameters, subjective outcomes, and body mass index. Complications of surgery were also analyzed.

Thirteen articles were critically evaluated for this research. However, only four case series qualified for statistical analysis of postoperative polysomnographic outcomes and six case series for analysis of postoperative complications. They were case series with a total of 451 adult patients. Pooled analysis revealed statistically significant improvements in AHI, LSAT, and ESS after surgery by 26.83/hour, 5.28% and -8.03, respectively. The average rates of surgical cure and success were 23.8% and 66.7%, respectively. No study reported any deaths or complications related to the use of robotic equipment. The major complication rate was 6.9%, and the minor complication rate was 30.0%. Major complications included major bleeding (2.9%), severe odynophagia with dehydration (3.3%), and oropharyngeal stenosis (0.7%). Minor complications included transient bleeding (0.5%), transient dysphagia (3.8%), and dysgeusia (6.6%).

TORS for tongue base reduction, as a component of multilevel surgery, is an effective treatment option for OSAHS with an acceptable morbidity. This conclusion is based on the analysis of the results of multiple case series. Future studies should entail prospective randomized controlled trials with larger sample size for longer follow-up period.