Transoral Robotic Lingual Tonsillectomy for Pediatric Obstructive Sleep Apnea

Our objective was to investigate the safety and efficacy of transoral robotic surgery (TORS) lingual tonsillectomy (LT) with and without epiglottopexy and to compare it with non-robotic approaches for children with obstructive sleep apnea (OSA).

A multi-institutional retrospective chart review was conducted on 56 patients who underwent TORS LT (32 males, 24 females; mean age 11.7 ± 4.2 years; 29 syndromic) between 2015 and 2024 at 2 tertiary care pediatric hospitals. Preoperative and postoperative polysomnogram data were collected and analyzed, along with clinical and demographic data to analyze predictors of surgical success.

Of the patients with pre- and postoperative polysomnogram, 26 patients (60.5%) were considered a surgical success. Significant improvements were seen in apnea hypopnea index (mean reduction of -14.39 ± 5.2; p = 0.0079), apnea hypopnea index during rapid eye movement (mean reduction of -25.89 ± 8.8; p = 0.0057), and O2 nadir (mean improvement of 5.73% ± 1.64%; p = 0.0012). There were no significant differences in the proportion of surgical success based on preoperative OSA severity, presence of a syndrome, or presence of obesity. Eleven patients experienced complications (19.6%), including postoperative hemorrhage requiring operative intervention (8.9%) and oropharyngeal scarring (3.6%).

For pediatric patients with OSA and lingual tonsillar hypertrophy, TORS is an effective and safe method of performing LT, with benefits including excellent 3-dimensional visualization and a greater ability to distinguish the lingual tonsil/tongue musculature interface. While this is the largest pediatric TORS LT study to date, further research with larger sample sizes and additional sleep and quality of life metrics would add to the existing literature.