A systematic review and meta-analysis of robot-assisted deep brain stimulation: comparative insights with...

Recent robotic-assisted surgical systems have shown promising efficiency and accuracy in brain surgeries. However, their application in deep brain stimulation (DBS) surgery remains limited.

Studies from the Embase, Scopus, and Pubmed databases were included using a modified search string, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted technical aspects of robotic-assisted DBS (RA-DBS) surgery, patient characteristics, accuracy, safety, and overall clinical results. We applied a random effects model for analysis. Heterogeneity was evaluated using Cochran's Q test and the I² statistic. Additionally, subgroup analysis was conducted for the type of anesthesia, and frame-based versus frameless procedures and using microelectrode recordings (MER). Quality appraisal was conducted using the Newcastle-Ottawa Scale.

The pooled mean radial error (RE) and Euclidean distance (3D-EE) in robotic surgeries were 1.04 mm (95% CI 0.93 to 1.15 mm) and 1.19 mm (95% CI: 0.94 - 1.45 mm). RA-DBS outcomes regarding RE were comparable to conventional stereotactic DBS (C-DBS) surgery (SMD: -0.56, 95% CI: -1.35 - 0.22, P-value: 0.16). Also, the difference in the rates of reported complications was insignificant (OR: 0.26, 95% CI: -0.64 - 1.15, P-value: 0.58). None of the frame-based or frameless (P-value: 0.36), the use of MER (P-value: 0.11), or the type of anesthesia (P-value: 0.27) showed significant differences. However, there was an insignificant lower RE trend in the studies that employed frame-based techniques, used general anesthesia, and did not utilize MER.

Our study shows an acceptable level of error associated with RA-DBS. We found that the accuracy and complication rates were comparable to C-DBS. Due to substantial heterogeneity in the pooled mean RE and 3D-EE, more studies with higher sample sizes are required to evaluate RA-DBS.