Effectiveness of transoral robotic tongue base surgery in patients with obstructive sleep Apnoea

Purpose: To evaluate the feasibility, morbidity, and efficacy of transoral robotic surgery (TORS) tongue base resection (TBR) combined with upper airway airflow-facilitating surgeries in patients with obstructive sleep apnoea (OSA) characterized by tongue base hypertrophy and collapse, and to identify anatomical and nonanatomical predictors of surgical success. Methods: This single-center, prospective observational cohort study included 110 adult patients with moderate to severe OSA (AHI ≥ 15) or positional OSA, who failed or refused conservative therapies. Retrolingual/hypopharyngeal obstruction and tongue base collapse were confirmed via drug-induced sleep endoscopy or flexible nasopharyngoscopy. Patients with contraindications for surgery, inadequate mouth opening, absence of postoperative polysomnography, or under 18 years of age were excluded. Demographic, polysomnographic, and perioperative data were collected and statistically analyzed. Results: The mean patient age was 47.4 ± 10.8 years, and mean BMI was 30.2 ± 4.0 kg/m²; 93.6% were male. All patients underwent TORS-TBR without the need for tracheostomy. The mean hospitalization period was 8.5 ± 4.3 days. Statistically significant differences between surgical success and failure groups included AHIREM, obstructive apnoea counts in REM and NREM, mean obstructive apnoea duration, total apnoea duration, lowest oxygen saturation, mean desaturation percentages, and sleep time with oxygen saturation below 90% (ST90). Postoperative polysomnography demonstrated significant improvements across almost all parameters. Based on surgical success criteria, 73.6% of patients achieved a successful outcome. Conclusion: Transoral robotic tongue base surgery, combined with individualized multilevel airway interventions, provides an effective, feasible early treatment option for OSA. This approach supports personalized management strategies and significantly improves polysomnographic outcomes, contributing to the reduction of OSA-related morbidity and mortality. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.