Transoral Robotic Surgery versus Plasma Ablation for Tongue Base Reduction in Obstructive Sleep Apnea: Meta-analysis

Otolaryngol Head Neck Surg. 2020 Jun;162(6):839-852. doi: 10.1177/0194599820913533. Epub 2020 Mar 24.


Objectives: To compare the effectiveness of transoral robotic surgery (TORS) versus plasma ablation (PA) in tongue base reduction surgery for obstructive sleep apnea (OSA).

Data sources: PubMed, Scopus, Cochrane Library, OVID.

Review methods: Keywords searched included OSA, tongue base surgery, TORS, and coblation. Outcomes included pre- to postoperative apnea-hypopnea index, Epworth Sleepiness Scale (ESS), and lowest oxygen saturation. Additional outcomes included surgical success rate, postoperative bleeding, operative time, and length of stay.

Results: A total of 690 unique articles were identified, of which 60 underwent full-text review. Twenty-six articles were included in final analysis, comprising 18 studies on TORS (834 patients) and 11 studies on PA (294 patients). Mean differences of apnea-hypopnea index, ESS, and lowest oxygen saturation for TORS were -23.92, -7.6, and 5.83% (all P < .01). Corresponding values for PA were -22.07, -4.14, and 5.48% (all P < .00001). TORS had greater ESS reduction than PA (P = .02). Follow-up duration was shorter in TORS than PA (mean ± SD: 4.2 ± 2.6 vs 4.6 ± 1.4 months, P = .0482). Surgical success rates in TORS and PA were similar (57.6% vs 60.3%, P = .4474). Postoperative bleeding occurred less frequently in TORS versus PA (3.3% vs 7.5%, P = .0103). Operative time was longer for TORS than PA (77.9 ± 16.4 minutes vs 44.0 ± 12.9 minutes, P < .0001). Length of stay was similar between TORS and PA (3.9 ± 1.6 days vs 3.9 ± 2.5 days, P = .9047).

Conclusion: Tongue base reduction with TORS or PA each effectively treats OSA and provides comparable results. The choice between techniques might depend on patient factors, availability of technology, and associated costs.

Keywords: base of tongue; coblation; glossectomy; lingual tonsillectomy; obstructive sleep apnea; plasma ablation; sleep disordered breathing; transoral robotic surgery.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Glossectomy / methods*
  • Humans
  • Mouth
  • Natural Orifice Endoscopic Surgery / methods*
  • Robotic Surgical Procedures / methods*
  • Sleep Apnea, Obstructive / surgery*
  • Treatment Outcome