Robot-assisted targeting for osteoid osteoma: a systematic review

Accurate nidus access is essential for treating osteoid osteoma, but the incremental contribution of physical robotic targeting should be distinguished from imaging, definitive treatment, and the wider care pathway. We systematically reviewed peer-reviewed human reports in which a robot physically positioned or constrained an instrument used for biopsy or treatment. PubMed/MEDLINE, Embase, Web of Science Core Collection, the Cochrane Library, Wanfang Data and the China National Knowledge Infrastructure were searched from inception through August 2026, without a final language restriction. Primary outcomes were success, recurrence or retreatment, and treatment-related complications. Secondary outcomes included localization, instrument corrections, radiation, procedure time, diagnostic yield, recovery, and cost. Twelve reports contained 440 report-level treatment records, including 232 robot-assisted procedures, before assessment of probable or possible overlap. Evidence comprised seven retrospective comparisons, four uncontrolled series, and one case report. Robot-proximal findings generally favored more reproducible or conservative access, including fewer Kirschner-wire corrections, shorter localization, greater resection accuracy, or a smaller bone window. Procedure-time effects varied by comparator and workflow. In comparisons that approximately held treatment constant, clinical success, later pain, recurrence, and complications were not clearly improved. Apparent advantages over open surgery mainly reflected minimally invasive access or treatment modality rather than robotic targeting alone. Meta-analysis was not performed because clinically equivalent comparisons were not independently replicated, outcome definitions differed, and cohort overlap was probable or possible. Comparative certainty was very low. Robotic targeting may improve trajectory execution in technically demanding lesions, but superior long-term effectiveness, safety, diagnostic adequacy, robot-attributable radiation reduction, and cost-effectiveness remain unproven.