Hypoglossal nerve stimulation (HGNS) surgery continues to increase in popularity with greater than 150 active centers worldwide. Like any surgical procedure, there can be both expected and unexpected intraoperative challenges. Using the combined experience of four highly experienced HGNS surgeons, this session will use a case-based format to present challenging cases personally faced by the panelists including left-sided implant, pre-existing breast implant, hemorrhage during lead tunneling, pediatric implantation, and others. Learning Objectives: 1. Demonstrate understanding of potential challenges in HGNS surgery. 2. Develop steps to overcome anatomic challenges once identified during surgery. 3. Execute surgical plan to optimize patient outcomes.Faculty: Raj Dedhia, MD(Nothing to Disclose), Ryan Soose, MD(Other: Cryosa Inc; Enhale Medical; Research funding: Inspire Medical Systems; Consulting Fees: Inspire Medical Systems; Galvani Bioelectronics; Invicta Medical; Cryosa Inc; Enhale Medical), Maurits Boon, MD(Honoraria: Inspire Medical; Research funding: Inspire Medical; Consulting Fees: Inspire Medical), Robson Capasso, MD(Stock or Stock Options: Snoozely; Stock or Stock Options: True Wearables; Consulting Fees: Johnson and Johnson).