Robot-assisted versus manually guided stereotactic biopsy for intracranial lesions - a systematic review and meta-analysis.

Stereotactic biopsies are essential for obtaining accurate histopathological analysis to guide treatment decisions for deep-seated brain lesions. Manually guided methods, while commonly used and highly precise, can be limited by potential inaccuracies and insufficient tissue sampling. The emerging robot-assisted (RA) techniques offer enhanced precision and could address these limitations for improved accuracy. We aimed to compare safety and effectiveness of RA stereotactic biopsies to traditional techniques. We conducted a systematic search of PubMed, Embase, and Web of Science using terms related to robotic biopsies and intracranial lesions. Eligible studies compared robot-assisted procedures to traditional techniques. Data extracted included diagnostic yield, complication rates, and accuracy. Quality assessment of studies was performed with the ROBINS-I tool, and a random-effects model meta-analysis was performed. Five studies were included, encompassing 913 patients (robot-assisted n = 434, traditional n = 479). Robot-assisted biopsies demonstrated higher diagnostic yield (OR 2.06, 95% CI [1.01,4.21], p = 0.04), and improved trajectory accuracy, with entry point error (EPE) reduced by 0.42 mm (95% CI [-0.59,-0.26], p < 0.001) and target point error (TPE) reduced by 0.93 mm (95% CI [-1.80,-0.06], p < 0.01). There were no significant differences in the incidence of complications or operative time. RA stereotactic biopsies may improve diagnostic yield and accuracy in targeting intracranial lesions without increasing complication rates or operative time. The limited number of studies and potential biases suggest a need for further high-quality, prospective research to ascertain these findings.