Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland.
Neurosurg Rev. 2024 Oct 15;47(1):799. doi: 10.1007/s10143-024-03039-y.
Intracerebral hemorrhage (ICH) is a severe condition in vascular neurological surgery, often leading to high mortality and severe disability. Recent advancements in robotic-assisted (RA) systems, including ROSA, Remebot, and CAS-R-2, have shown promise in enhancing surgical precision and outcomes. This study aims to evaluate the effectiveness of RA systems in ICH surgery compared to conventional methods. This systematic review followed PRISMA 2020 guidelines. The inclusion criteria were peer-reviewed English language articles reporting on the use of RA systems for ICH surgery in humans. Data extraction focused on surgical time, mortality rates, neurological outcomes, complication rates, and economic effectiveness. Meta-analyses were performed using R software, employing a random effects model to account for variations between studies. Seventeen studies were included in the systematic review, with thirteen qualifying for the meta-analysis. The results demonstrated that RA systems significantly reduced surgery time (MD -86.2447 [-128.5111; -43.9782], p < 0.0001) and mortality at last follow-up (OR 0.3652 [0.1457; 0.9158], p = 0.0317). RA systems also improved neurological outcomes, with lower mean modified Rankin Scale (mRS) scores (MD -0.8063 [-1.0786; -0.5341], p < 0.0001) and higher Glasgow Outcome Scale (GOS) scores (MD 0.6792 [0.1599; 1.1985], p = 0.0104). Complications such as rebleeding, pulmonary infections, and intracranial infections were significantly reduced. Robot-assisted surgery may provide benefits in ICH surgery, by reducing surgery time, lowering rates of mortality, better neurological outcomes, and reduced complications. Currently, the published studies are highly prone to bias and many outcomes are very heterogenous. Additional research done on larger, more standardized studies is needed for the full ascertainment of such techniques in being integrated into normal clinical practice.
脑出血 (ICH) 是血管神经外科中的一种严重病症,常导致高死亡率和严重残疾。机器人辅助 (RA) 系统,包括 ROSA、Remebot 和 CAS-R-2,在提高手术精度和结果方面显示出了前景。本研究旨在评估 RA 系统在 ICH 手术中的有效性,与传统方法相比。本系统评价遵循 PRISMA 2020 指南。纳入标准是同行评议的英文文献,报告了 RA 系统在人类 ICH 手术中的应用。数据提取侧重于手术时间、死亡率、神经功能结果、并发症发生率和经济有效性。使用 R 软件进行荟萃分析,采用随机效应模型来解释研究之间的差异。本系统评价纳入了 17 项研究,其中 13 项符合荟萃分析的条件。结果表明,RA 系统显著缩短了手术时间(MD-86.2447[-128.5111; -43.9782],p<0.0001)和末次随访时的死亡率(OR 0.3652[0.1457; 0.9158],p=0.0317)。RA 系统还改善了神经功能结果,较低的平均改良 Rankin 量表(mRS)评分(MD-0.8063[-1.0786; -0.5341],p<0.0001)和较高的格拉斯哥结局量表(GOS)评分(MD 0.6792[0.1599; 1.1985],p=0.0104)。再出血、肺部感染和颅内感染等并发症明显减少。机器人辅助手术可能通过缩短手术时间、降低死亡率、改善神经功能结果和减少并发症,为 ICH 手术带来益处。目前,已发表的研究高度偏向,许多结果非常异质。需要在更大、更标准化的研究中进行进一步研究,以充分确定这些技术整合到常规临床实践中的情况。