Da Vinci Robotic Surgery (TORS) for Sleep Apnea in Madrid
Medically reviewed by Dr. Iván Méndez-Benegassi Silva · ENT & Sleep Medicine Specialist · HM Hospitales, Madrid · License No. 282855946
The tongue base and epiglottis are areas of difficult manual access. Thanks to the da Vinci robotic system (Trans-Oral Robotic Surgery), we can perform resections with millimetric precision, without external incisions, reducing bleeding and accelerating recovery.
Sleep apnea and robotic surgery, explained (video)
Specific Procedures
Lingual Tonsil Surgery
Removal of hypertrophic lymphoid tissue at the tongue base that blocks airflow. Robotics allows preservation of lingual vessels and nerves.
Partial Epiglottectomy
For patients with a "floppy" or redundant epiglottis that falls over the larynx during sleep. The upper part of the epiglottis is trimmed to stabilize it.
Robotic Barbed Repositioning Pharyngoplasty (BRP)
Integration of the robot to optimize muscular tension in the lateral pharyngeal walls.
Who is it for?
It is aimed at patients with sleep apnea or snoring whose obstruction is at the tongue base or the lingual tonsil, and in selected cases with a redundant epiglottis. The level and pattern of collapse should be confirmed beforehand with a sleep endoscopy (DISE), so that operating on this area is justified and a poorly indicated procedure is avoided.
Recovery
As there are no external incisions, the wound stays inside the mouth and recovery tends to be faster than with open approaches. It usually involves a short hospital stay of one to two days, with throat pain on swallowing during the first days and a progressive diet starting with soft, cold foods. Each recovery is individual and is followed up by the specialist.
Scientific Evidence & Clinical Results
Daytime Sleepiness & Breathing
In meta-analyses of tongue-base TORS, daytime sleepiness and breathing improve meaningfully in selected patients: the Epworth Sleepiness Scale falls by about 7.9 points on average and the apnea-hypopnea index (AHI) drops by roughly 24 events per hour. A more recent 2025 meta-analysis confirms the same direction, with improvements in the AHI, the Epworth scale and the lowest oxygen saturation during sleep.
References: Gupta et al., meta-analysis (Clinical Otolaryngology, 2025); Lechien et al., systematic review & meta-analysis (Head & Neck, 2021).
An Option When CPAP Fails
For carefully selected patients with retroglossal collapse (at the tongue base) who cannot tolerate or refuse CPAP, TORS is an effective structural option that physically widens the airway. It does not work for everyone: the level of collapse must be confirmed with a sleep endoscopy (DISE), and apnea is not always fully resolved.
References: Vicini et al., pioneers of TORS for OSA (2010); Meccariello et al., meta-analysis (Eur Arch Otorhinolaryngol, 2016).
Success Rate & Multilevel Surgery
TORS is a cornerstone of multilevel surgery rather than a guaranteed cure. By the standard criterion (a >50% reduction in AHI with a final AHI below 20), success is reached in roughly 54% to 83% of carefully selected patients. Combining tongue-base TORS with palate (barbed pharyngoplasty) or nasal procedures addresses collapse at several levels for the best overall result.
References: Meccariello et al., meta-analysis (Eur Arch Otorhinolaryngol, 2016); Lechien et al., systematic review & meta-analysis (Head & Neck, 2021).
Frequently asked questions
What is TORS robotic surgery and what does the da Vinci robot do?
TORS (Trans-Oral Robotic Surgery) is a technique that operates through the mouth, without external incisions in the neck. The da Vinci robot does not act on its own: the surgeon controls it from a console and the robotic arms reproduce their movements with millimetric precision in zones of difficult manual access, such as the tongue base and the epiglottis.
Which patients is it indicated for?
It is aimed at patients with sleep apnea or snoring whose obstruction is at the tongue base or the lingual tonsil (the lymphoid tissue at the back of the tongue), and in selected cases with a redundant epiglottis. The exact level and pattern of collapse should be confirmed beforehand with a sleep endoscopy (DISE) to make sure that operating on this area makes sense.
What is the recovery like? Does it hurt?
It usually involves a short hospital stay of one to two days. As there are no external incisions, the wound is inside the mouth, so the main discomfort is throat pain on swallowing during the first days, controlled with painkillers. The diet is progressive, starting with soft and cold foods, and most patients return to normal life within a couple of weeks.
What risks does it have?
Like any surgery in this area, it can cause throat pain, bleeding, temporary difficulty or discomfort when swallowing and, more rarely, changes in taste. The need to convert to open surgery is very exceptional. Any procedure should be assessed individually, weighing its risks against the expected benefit in each case.
Is it the same as tongue base surgery?
It is one way of doing it. "Tongue base surgery" refers to the goal — reducing the tissue that obstructs at the back of the tongue — while TORS is the robotic route used to reach it through the mouth with greater precision and without external incisions. The same area can also be treated with other techniques; the robot is a tool, not a different diagnosis.