Abstract
PURPOSE: Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse, leading to intermittent hypoxia and sleep fragmentation. Posterior midline glossectomy is a widely used technique to treat tongue base obstruction typically performed as part of multilevel management. This systematic review compares the efficacy and safety of robotic versus non-robotic glossectomy techniques in OSA management. METHODS: Four databases were searched through July 2024. Eligible studies included adult patients with OSA undergoing robotic or non-robotic posterior midline glossectomy, with outcomes including apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), oxygen saturation, complications, and surgical success. Meta-analysis was performed using RevMan v5.4. RESULTS: Thirty-six studies (n = 6,995 patients) were included. Both robotic and non-robotic approaches resulted in significant AHI reduction (robotic: − 25.93; non-robotic: − 24.99). Oxygen nadir improved in both groups (robotic: +5.48%; non-robotic: +8.11). ESS scores decreased in both arms (robotic: − 7.43; non-robotic: − 5.58). Overall success rates were similar (robotic: 64%; non-robotic: 57%). Major complications, particularly postoperative bleeding and edema, were more frequent with robotic surgery. CONCLUSION: Robotic and non-robotic posterior glossectomy yield comparable improvements in OSA outcomes. Robotic techniques may offer slighlty greater symptom reduction but are associated with higher complication rates. These findings support individualized surgical planning based on anatomy, risk profile, and resource availability. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11325-026-03637-8.