Anaesthesia Management of Transoral Robotic Surgery for Sleep Apnoea (TORSA): A New Challenge

Background: Obstructive sleep apnoea (OSA) is a common disorder associated with excessive daytime sleepiness, reduced work performance, and long-term cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard therapy, but many patients are unable to tolerate it due to discomfort or intolerance. Transoral Robotic Surgery for Sleep Apnoea (TORSA) has emerged as an alternative option, offering enhanced precision, ergonomics, and three-dimensional visualization. However, TORSA presents unique anaesthetic challenges that require meticulous preparation. Aim: To outline key anaesthetic considerations and perioperative strategies essential for the safe conduct of TORSA. Methods: This descriptive review is based on institutional experience and existing literature on TORSA. Key elements analysed include operating room setup, anaesthesia workstation positioning, airway management techniques, hemodynamic control during instrumentation, robotic undocking preparedness, and postoperative airway care. Results: Optimal OT layout is crucial, with the anaesthesia workstation placed at the foot end to allow robotic docking at the head end. A nasal RAE tube ensures unobstructed access to the surgical field. Adequate muscle relaxation, eye protection, and careful patient positioning are essential. Sympathetic surges during mouth gag placement and robotic arm insertion can be managed by adjusting anaesthetic depth or administering intravenous boluses. Emergency undocking protocols must be well rehearsed due to restricted access once docking is complete. Postoperative concerns include airway oedema, bleeding, and safe extubation after confirming adequate airway patency. Conclusion: TORSA is a promising option for CPAP-intolerant OSA patients. Successful anaesthetic management requires comprehensive planning, coordinated teamwork, and familiarity with robotic workflow to ensure safety throughout the perioperative period.