Robot-assisted versus conventional cranial stereotactic neurosurgery: a systematic review and meta-analysis of targeting accuracy, procedural efficiency, and safety.
Yiqun Dong, Shuo Zhang, Yanxi Bao et al.
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In 30 seconds
This systematic review and meta-analysis compared robot-assisted with conventional cranial stereotactic neurosurgery across 21 comparative studies, examining targeting accuracy, procedural efficiency, safety and clinical outcomes by surgical application. In an exploratory synthesis of three studies, targeting accuracy favored robotic assistance under the DerSimonian-Laird/Wald analysis (g=1.03, 95% CI 0.36-1.69; I 2 =78.5%), but the prediction interval crossed zero and alternative analyses produced confidence intervals crossing zero. Two biopsy studies also suggested shorter procedure duration with robotic assistance, although Hartung-Knapp intervals crossed zero. The review found no established link between improved targeting and better clinical outcomes.
Key findings
- Three-study accuracy synthesis favored robotic assistance under DL/Wald (g=1.03, 95% CI 0.36-1.69; I 2 =78.5%), but the prediction interval crossed zero.
- REML/HK analysis of accuracy yielded g=1.03 (95% CI -0.41-2.47; P=0.092); modified HK gave a similar result.
- Two biopsy studies favored shorter procedure duration with robotic assistance under DL/Wald (18.48 min, 95% CI 11.46-25.49), while HK intervals crossed zero.
- Risk-of-bias judgments were serious in 17 studies, critical in one, moderate in one, and some concerns in two.
Why it matters
Robotic assistance may offer technical accuracy or timing advantages in selected cranial biopsy cohorts, but the evidence does not establish generalized superiority across stereotactic applications. The distinction matters because pooled estimates were sensitive to statistical methods, studies varied in procedures and outcome definitions, and improved targeting was not consistently associated with better clinical outcomes.
What to keep in mind
The evidence base was small for pooled outcomes, heterogeneous, and at substantial risk of bias; conclusions changed with interval-estimation methods. The review reports no consistent association between targeting improvements and better clinical outcomes.