Transoral Robotic Surgery Versus Traditional Lingual Tonsillectomy for Persistent Pediatric Sleep Apnea.

OBJECTIVES

This study compares postoperative outcomes of transoral robotic surgery (TORS) and traditional lingual tonsillectomy in pediatric patients with persistent obstructive sleep apnea (OSA) following tonsillectomy and adenoidectomy (T&A).

METHODS

A systematic search of Ovid MEDLINE, Embase, Cochrane CENTRAL, and Web of Science was conducted through January 2026. Inclusion criteria: pediatric patients (< 18 years) with persistent OSA following T&A, TORS, or traditional lingual tonsillectomy. Outcomes assessed included postoperative apnea-hypopnea index (AHI) reduction, bleeding, and non-bleeding complications.

RESULTS

A total of 17 studies were analyzed (n = 470; 25 TORS and 445 traditional procedures). Postoperative dysphagia was significantly higher among TORS (32%) versus traditional (1.3%; p < 0.001). Postoperative infection rates were greater after TORS (16% vs. 1.3%; χ 2 = 14.88, p < 0.001). Meta-analysis demonstrated significantly greater postoperative bleeding with TORS (12%) versus traditional (3%, χ 2 = 3.98, p = 0.046). AHI reduction was greater in TORS (mean: 16.20 events/h, 95% CI: 9.01-23.39) than in traditional (mean: 3.64 events/h, 95% CI: 2.03-5.25), with a significant subgroup difference (χ 2 = 11.41, p < 0.001) indicating greater symptom resolution following TORS. No significant differences were observed in postoperative airway obstruction or bleeding requiring surgical intervention.

CONCLUSION

Although TORS offers greater improvements in persistent pediatric OSA following T&A, its association with higher rates of postoperative dysphagia, infection, and bleeding warrants careful decision-making and further investigation in larger cohorts to refine patient selection and optimize outcomes.