Transoral Robotic Surgery Versus Traditional Lingual Tonsillectomy for Persistent Pediatric Sleep Apnea

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Robotic Surgery

Background:

• Persistent obstructive sleep apnea (OSA) in children after tonsillectomy and adenoidectomy (T&A) often requires further intervention.
• Lingual tonsil hypertrophy is a common cause of residual OSA in pediatric patients.

Purpose of the Study:

• To compare the postoperative outcomes of transoral robotic surgery (TORS) versus traditional lingual tonsillectomy for pediatric patients with persistent OSA post-T&A.
• To evaluate the efficacy and safety of TORS in managing residual pediatric OSA.

Main Methods:

• A systematic literature search was performed across major databases (Ovid MEDLINE, Embase, Cochrane CENTRAL, Web of Science) up to January 2026.
• Inclusion criteria focused on pediatric patients (<18 years) with persistent OSA post-T&A, undergoing either TORS or traditional lingual tonsillectomy.
• Key outcomes assessed included apnea-hypopnea index (AHI) reduction, bleeding complications, and non-bleeding complications.

Main Results:

• Analysis of 17 studies (n=470) revealed significantly higher rates of postoperative dysphagia (32% vs. 1.3%) and infection (16% vs. 1.3%) with TORS compared to traditional methods.
• Meta-analysis indicated greater postoperative bleeding with TORS (12% vs. 3%), though no significant difference in bleeding requiring surgical intervention was found.
• TORS demonstrated significantly greater AHI reduction (mean 16.20 events/h vs. 3.64 events/h), suggesting superior symptom resolution.

Conclusions:

• TORS offers superior improvement in persistent pediatric OSA following T&A.
• Higher rates of postoperative dysphagia, infection, and bleeding associated with TORS necessitate careful patient selection and further research.
• Larger cohort studies are recommended to refine TORS patient selection criteria and optimize outcomes for pediatric OSA management.