Tag: robotic

Posted on

Spinal versus general anesthesia in robotic minimally invasive transforaminal lumbar interbody fusion: a comparative study on surgical outcomes

J Neurosurg Spine 44:99–107, 2026

This clinical study compares spinal anesthesia (SA) versus general anesthesia (GA) for robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA‑MIS TLIF), reporting retrospective outcomes from 209 patients treated 2018–2024. Primary findings show SA patients had significantly shorter operative times, lower immediate postoperative pain scores, reduced estimated blood loss, and shorter hospital length of stay after propensity score matching and regression adjustment.

The authors contextualize results within advances in robotic spinal surgery and awake spine techniques, discuss safety and potential cost and opioid‑reduction benefits, and acknowledge limitations including retrospective design, single‑center data, and reduced matched cohort size. Conclusions support SA as a safe, efficient approach for RA‑MIS TLIF with calls for larger prospective studies and formal patient‑selection guidelines.

Spinal Anesthesia (SA) vs General Anesthesia (GA): In robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA-MIS TLIF), SA significantly reduces operative times, postoperative pain, and hospital length of stay compared to GA, with no increase in complications or adverse outcomes.

Robotic Assistance Benefits: Robotic technology in spine surgery improves pedicle screw placement accuracy, reduces radiation exposure, and is associated with lower complication and revision rates, enhancing surgical safety and efficiency.

Study Design: A retrospective analysis of 209 patients (31 SA, 178 GA) from 2018–2024, with propensity score matching applied to control for confounders, allowing fair comparison between SA and GA cohorts for single-level procedures.

Key Outcomes (After Matching): SA cohort had shorter median total OR time (159 vs 283 min), procedure time (115 vs 201 min), lower intraoperative blood loss (25 vs 50 mL), lower first postoperative pain scores (median VAS 0 vs 5), and reduced mean length of stay (0.90 vs 2.64 days) compared to GA.

Patient Selection: The choice between SA and GA was based on patient preference and eligibility, with all SA cases being single-level procedures and comparable baseline demographics after matching.

Safety Profile: No increase in intraoperative or postoperative complications was observed with SA; screw placement accuracy remained high with robotic assistance.

Implications for Practice: Combining SA with RA-MIS TLIF offers a safe, efficient, and patient-centered approach that may lower healthcare costs and opioid requirements by reducing pain and hospitalization.

Limitations: Single-center, retrospective design with a relatively small matched cohort may limit generalizability; further prospective, multicenter studies are needed to validate these findings.

Posted on

Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain Biopsies: A Systematic Review and Meta-Analysis

Operative Neurosurgery 28:749–761, 2025

This systematic review and meta-analysis compares frame-based, frameless, and robot-assisted stereotactic brain biopsies. Robot-assisted biopsies demonstrated non-inferior diagnostic yield and safety compared to traditional methods, with shorter operative times. Complication and mortality rates were similar across all techniques, supporting robot-assisted biopsy as an effective alternative.

• Frame-based stereotactic brain biopsy has been the gold standard for high diagnostic yield and safety, especially for complex or deep-seated lesions.

• Frameless neuronavigation and robot-assisted techniques have emerged as alternatives over the past decade.

• Meta-analysis included 92 studies: 9801 frame-based, 2665 robot-assisted, and 1862 frameless cases.

• Pooled diagnostic yields: robot-assisted 97%, frame-based 95%, frameless 94%; robot-assisted was not inferior.

• Complication and mortality rates were low and similar across all methods.

• Robot-assisted procedures had significantly shorter total operative times (mean 76.6 min) compared to frame-based (132.7 min) and frameless (97.3 min).

• Diagnostic yield for brainstem lesions was comparable between robot-assisted and frame-based approaches.

• Robot-assisted biopsy may offer workflow, comfort, and efficiency advantages, especially for certain patient groups.

Posted on

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Frameless robotic stereotactic biopsies- a consecutive series of 100 cases

J Neurosurg 122:342–352, 2015

Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device.

Methods The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported.

Results A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy.

Conclusions ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

Proudly powered by WordPress