Objectives/Hypothesis: Transoral robotic surgery (TORS) in the base of the tongue (BOT) reduction has been shown to decrease the apnea-hypopnea index (AHI) and improve daytime sleepiness in obstructive sleep apnea (OSA) patients. Intraoperative ultrasound (IOU) can be employed to guide the surgery and prevent massive bleeding. Study Design: Cohort study with historical control. Methods: A cohort study to compare the outcomes between OSA patients who received TORS with and without IOU assistance. Results: From 2016 to 2019, this study enrolled 80 OSA patients who underwent TORS in BOT: 57 in the IOU(+) and 23 in IOU(−) groups. The TORS with IOU presented with shorter operative time, less blood loss, and greater excised BOT volume. The IOU(+) group had greater improvement in the AHI and subjective questionnaire evaluation. The excised volume of BOT was significantly associated with the change in AHI. Conclusion: The IOU could improve outcomes in BOT reduction surgery without raising the risk of surgical complications. Level of Evidence: 4 Laryngoscope, 132:1125–1131, 2022.
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