Yesterday I had the privilege of speaking at the XXXII Congress of the Society of Otolaryngology of Castilla y León, Cantabria and La Rioja, held in the beautiful city of Ávila, where I presented my perspective on the role of TransOral Robotic Surgery (TORS) in the management of Obstructive Sleep Apnea (OSA).
Over the last fifteen years, I have witnessed the evolution of robotic surgery in Head&Neck Surgery from its early adoption to its current maturity. When we started our TORS program, many of us believed that robotic surgery would become a common surgical solution for OSA. Reality has been more nuanced.
My main message today is simple and obvious: TORS is an excellent tool, but it is not the solution for every patient with OSA.
TORS is an excellent tool, but it is not the solution for every patient with OSA.
The management of OSA has evolved. Weight-loss therapies, positional treatment, myofunctional therapy, mandibular advancement devices, neurostimulation, CPAP, and a growing range of surgical techniques have expanded our therapeutic arsenal. In this context, robotic surgery should be viewed as one component of a comprehensive and individualized treatment strategy.
For carefully selected patients, particularly those with significant tongue base or supraglottic obstruction identified through systematic examination and Drug-Induced Sleep Endoscopy (DISE), TORS offers clear technical advantages. Three-dimensional visualization, superior instrument articulation, and precise access to difficult anatomical areas allow effective treatment of obstruction at the tongue base and epiglottis.
However, the success of sleep surgery depends far more on patient selection than on the surgical technology itself. The evidence accumulated over the last decade consistently shows that TORS can achieve excellent outcomes as part of a multilevel surgical approach, but its benefits are closely linked to appropriate indications rather than the robotic platform alone.
So the debate is not “Should we use robotic surgery?” but “Which patient would benefit?” or better, “Which is the treatment scheme we should use for this particular patient?”
TORS for OSA is always part of a longer story.
J Granell. Jun 6, 2026
References
1.Justin GA, Chang ET, Camacho M, Brietzke SE. Transoral Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2016 May;154(5):835-46. doi: 10.1177/0194599816630962. Epub 2016 Mar 1.
2.Lechien JR, Chiesa-Estomba CM, Fakhry N, Saussez S, Badr I, Ayad T, Chekkoury-Idrissi Y, Melkane AE, Bahgat A, Crevier-Buchman L, Blumen M, Cammaroto G, Vicini C, Hans S. Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis. Head Neck. 2021 Jul;43(7):2216-2239. doi: 10.1002/hed.26702.
3.Mouratidou S, Chaidas K. Transoral Robotic Surgery for Patients with Obstructive Sleep Apnoea: A Systematic Literature Review of Current Practices. Life (Basel). 2024 Dec 22;14(12):1700. doi: 10.3390/life14121700.