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Comprehensive Otolaryngology

(212) Comparing complication rates of transoral robotic surgery vs. conventional tonsillectomy

Saturday, October 17, 2026

Presenting Author(s)

AM

Amer Mansour, MD

Resident
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Department of Otolaryngology-Head and Neck Surgery
Buffalo, New York, United States
Abraham A. Kassem, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Department of Otolaryngology, Head and Neck Surgery
Buffalo, New York, United States

Co-Author(s)

Gabriella N. Fletcher

Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
North tonawanda, New York, United States
MM

Monique Martin, n/a

Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, United States

Senior Author(s)

AA

Ayham Al-Afif, MD

Assistant Professor Fellowship Director - Head & Neck Oncology, Microvascular Reconstruction
Dalhousie University, Division of Otolaryngology - Head and Neck Surgery, Department of Surgery
Halifax, Nova Scotia, Canada
Michele M. Carr, DDS MD MEd PhD

Professor
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Dept of Otolaryngology
Buffalo, NY, United States

Introduction: Transoral robotic surgery (TORS) provides improved access to anatomically challenging regions of the head and neck. With limited available data comparing the complication rate of TORS vs. conventional tonsillectomy, we aimed to compare the complication rates of these approaches.

Methods: A retrospective cohort study using the TriNetX US Collaborative Network compared post-operative bleeding and dysphagia between robotic (RT) and conventional tonsillectomy (CT) from 1/1/2015 to 12/31/2024, excluding patients with head and neck malignancy. Outcomes included postoperative hemorrhage and dysphagia or other specified postprocedural states. Cohorts were propensity score matched 1:1 based on age, sex, race, ethnicity, obstructive sleep apnea, streptococcal pharyngitis, and streptococcal tonsillitis. Risk differences, risk ratios, and odds ratios with 95% confidence intervals were calculated, with p<.05 considered significant.

Results: 68,954 patients underwent CT and 281 underwent RT; robotic patients were older (mean age 43.9 ± 14.9 vs 25.5 ± 15.6 years) and more frequently female (213/281 [75.8%] vs 43,888/68,954 [63.6%]). After 1:1 propensity score matching, 281 patients remained in each cohort with comparable age (43.9 ± 15.2 vs 43.9 ± 14.9 years) and female representation (213/281 [75.8%]) in both cohorts. Postoperative hemorrhage occurred in 67/281 (23.8%) patients following CT and 35/281 (12.5%) following RT (risk ratio (RR) 1.91, 95% CI 1.32–2.78; odds ratio (OR) 2.20, 95% CI 1.41–3.44; p=.0005). Postoperative dysphagia occurred in 47/281 (16.7%) patients following CT and 67/281 (23.8%) following RT (RR 0.70, 95% CI 0.50–0.98; OR 0.64, 95% CI 0.42–0.97; p =.036).

Conclusions: Robotic tonsillectomy is a safe surgical approach and may be associated with a reduced risk of postoperative hemorrhage, supporting its use in appropriately selected patients.