Background: Bilateral hypoglossal nerve stimulation (biHNS) is a therapeutic option for treating patients with obstructive sleep apnea (OSA) unable to tolerate positive airway pressure therapy[1]. The duration of surgery for biHNS is critical, as it affects procedural costs and hospital resources. However, studies on the temporal progression of surgery duration are limited. Investigating the trends in surgical times and key factors influencing surgery duration is essential for optimizing this intervention. Material and methods: We analyzed surgery duration of biHNS implantation over a 4- year time period (n=33). Subjective difficulty rating was evaluated using a standardized questionnaire after the procedure and patient characteristics were assessed preoperatively. Results: This study demonstrated that surgical times progressively decrease as a surgeon gains experience performing implant procedures (Durationmin (min): 60, Durationmed (min): 120, Durationmax (min): 160.. Surgery duration is even shorter when two experienced surgeons work together. There was a strong correlation between the self-assessed difficulty of the implantation and the duration of the operation (r = 0,63). The duration of surgery appears to be independent of patient factors such as cricomental space, neck circumference and BMI.Discussion: Our study highlights that increased surgical experience and collaboration between skilled surgeons reduce operating times for biHNS. The strong correlation between perceived procedural difficulty and duration suggests that intraoperative challenges play a larger role than patient anatomy in influencing surgery duration. Emphasizing collaborative practices and refining techniques could further optimize procedural efficiency. [1]P. R. Eastwood et al., Jan. 2020

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