Transoral Robotic Surgery for Patients with Obstructive Sleep Apnoea: A Systematic Literature Review of Current Practices.

Transoral robotic surgery (TORS) for tongue base reduction (TBR) and/or epiglottic surgery is an effective treatment option for selected patients with moderate to severe obstructive sleep apnoea (OSA). This systematic review aims to provide an up-to-date overview of current practices and challenges associated with TORS for OSA. PubMed and Embase databases were searched up to December 2022 following PRISMA guidelines. Primary outcome measures were surgical technique, intraoperative measures, postoperative management and complications. A total of 32 articles, including 2546 patients, met the inclusion criteria. TORS was most commonly performed as part of a multilevel surgical approach. Nasotracheal intubation was the preferred method for general anaesthesia. The surgical technique for TORS tongue base and epiglottis did not differ significantly among institutions, although some variations exist. Postoperative management varied, with most authors aiming for immediate postoperative extubation, routine postoperative ward admission and early oral intake initiation. Common postoperative complications were dysphagia and bleeding, with no reported mortality. TORS is established as a safe and feasible surgical option for selected OSA patients, addressing tongue base and/or epiglottic obstruction. However, further studies are required to determine patients' selection criteria, preferred volume of excised tongue tissue and to assess the necessity for postoperative intensive care unit monitoring.