Published Oct 24, 2026
Updated Oct 24, 2026
Transoral robotic surgery (TORS) is most closely associated with Head&Neck Cancer, but its potential extends beyond oncological surgery. One of the surgeons who helped establish this broader role was Claudio Vicini, the Italian otolaryngologist who pioneered the application of TORS to obstructive sleep apnea (OSA), particularly through volume-reduction surgery at the base of the tongue.
From Head&Neck surgery to sleep surgery
Vicini trained in otolaryngology at the University of Pisa and subsequently specialised in audiology and neurology. His multidisciplinary background became particularly relevant to sleep-disordered breathing, a field in which understanding airway anatomy, respiratory physiology and the functional consequences of surgery is essential.
Based at the G. B. Morgagni–L. Pierantoni Hospital in Forlì, Italy, Vicini developed a major clinical and academic programme in sleep surgery. He led the hospital’s Otolaryngology–Head&Neck Surgery Unit for more than three decades and directed the Department of Head&Neck Surgery of the Romagna health authority. He also held academic appointments at the universities of Ferrara and Bologna and served as President of the Italian Society of Otolaryngology (SIO) in 2018–2019.
His work in sleep surgery was not limited to robotic technology. He contributed to the development of diagnostic pathways, patient selection and multidisciplinary approaches to obstructive sleep apnea, helping to position sleep surgery as a field requiring careful anatomical and functional assessment rather than a single standardised operation.
Adapting TORS for OSA
The application of TORS to OSA represented a different use of the robotic platform. Instead of removing a tumour, the objective was to enlarge the retrolingual airway by reducing obstructing tissue at the base of the tongue.
Vicini and his collaborators explored whether the three-dimensional visualisation and articulated instruments of the da Vinci system could facilitate this surgery through the mouth, allowing precise access to a region that is difficult to reach with conventional transoral techniques.
In 2010, Vicini and colleagues published a preliminary clinical report evaluating TORS for patients whose OSA was principally associated with tongue-base hypertrophy. Their initial series included 17 patients. This was followed by further anatomical and clinical work, including a 2012 publication describing the surgical anatomy of the tongue base and reporting experience with 44 patients who underwent robotic tongue-base resection.
These studies helped establish the technical foundations of robotic tongue-base surgery for sleep apnea. Subsequent work examined how tongue-base resection could be combined with palatal procedures, reflecting the multilevel nature of upper-airway obstruction in many patients.
The significance of this work lies not simply in applying a robot to an existing operation, but in adapting a technology developed for one surgical purpose to address a different clinical problem. It also helped establish a framework for evaluating TORS in sleep surgery, where patient selection, the sites of obstruction and objective postoperative outcomes are central to assessing success.
TORS is not a universal solution for OSA, and its effectiveness depends on appropriate selection and the pattern of airway obstruction. Nevertheless, Vicini’s work helped turn robotic tongue-base surgery from a promising concept into a defined clinical approach that could be studied, refined and taught.
Epilogue
No account of Vicini’s work in robotic sleep surgery would be complete without acknowledging Filippo Montevecchi, his long-standing collaborator and a key figure in the development and dissemination of this approach. Montevecchi’s sustained collaboration with Vicini is an important part of that story.
Also, for me, this connection has a personal dimension, as Filippo was my proctor for TORS.
Scott Magnuson co-directed the International Obstructive Sleep Apnea Surgery Course at Florida’s Nicholson Center alongside Vicini and Montevecchi, helping build a forum where surgeons from different countries could share experience, discuss patient selection and learn the technique (the tenth-anniversary edition was held in Celebration, Florida, in 2023). This transatlantic collaboration helped carry Vicini’s work beyond its Italian origins and contributed to the international exchange of knowledge that shaped the development of robotic sleep surgery.
Related posts (in this Web)
Claudio Vicini: bringing TORS to sleep surgery Oct 24, 2026
References
Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report. ORL J Otorhinolaryngol Relat Spec. 2010;72(1):22-7. doi: 10.1159/000284352.
Vicini C, Dallan I, Canzi P, Frassineti S, Nacci A, Seccia V, Panicucci E, Grazia La Pietra M, Montevecchi F, Tschabitscher M. Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: anatomic considerations and clinical experience. Head Neck. 2012 Jan;34(1):15-22. doi: 10.1002/hed.21691.
Crawford JA, Montevecchi F, Vicini C, Magnuson JS. Transoral robotic sleep surgery: the obstructive sleep apnea-hypopnea syndrome. Otolaryngol Clin North Am. 2014 Jun;47(3):397-406. doi: 10.1016/j.otc.2014.03.004.
Vicini C, Montevecchi F, Gobbi R, De Vito A, Meccariello G. Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique. World J Otorhinolaryngol Head Neck Surg. 2017 Jun 13;3(2):97-100. doi: 10.1016/j.wjorl.2017.05.003.
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