Transoral Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Grant A. Justin*, Edward T. Chang, Macario Camacho, Scott E. Brietzke

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

35 Scopus citations

Abstract

Objective To perform a systematic review of the international biomedical literature evaluating the effectiveness, complications, and safety of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE, Embase, and EMB Reviews databases were searched up to November 27, 2015. Review Methods Two authors systematically and independently searched for articles on TORS for the treatment of OSA in adults that reported either outcomes for the apnea-hypopnea index (AHI), lowest oxygen saturation percentage (LSAT) or changes in the Epworth Sleepiness Scale (ESS), and/or rates and types of complications associated with the operation. Results In total, 181 records were identified and 16 articles met inclusion criteria. Transoral robotic surgery was almost always combined with other sleep surgery procedures. The summary estimate of the decrease in AHI using TORS as part of a multilevel surgical approach was 24.0 (95% confidence interval [CI], 22.1-25.8; P <.001, I2 = 99%). The summary estimate of a decrease in ESS score was 7.2 (95% CI, 6.6-7.7; P <.001, I2 = 99%) and of the overall surgical "success" (defined as AHI <20 and 50% reduction) was 48.2% (95% CI, 38.8%-57.7%; P <.001, I2 = 99%). Three large studies reported on their total complication rates with an average of 22.3% (range, 20.5%-24.7%). Conclusions The initial results for the use of TORS as part of a multilevel surgical approach for OSA are promising for select patients. However, the cost and morbidity may be greater than with other techniques offsetting its advantages in visualization and precision. More prospective studies are needed to determine the optimal role of this tool.

Original languageEnglish
Pages (from-to)835-846
Number of pages12
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume154
Issue number5
DOIs
StatePublished - May 2016
Externally publishedYes

Keywords

  • TORS
  • base of tongue
  • obstructive sleep apnea
  • sleep-disordered breathing
  • transoral robotic surgery

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