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

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.