A Bulk Retrospective Study of Robot-Assisted Stereotactic Biopsies of Intracranial Lesions Guided by Videometric Tracker

Abstract

Background: Biopsies play an important role in the diagnosis of intracranial lesions, and robot-assisted procedures are increasingly common in neurosurgery centers. This research investigates the diagnoses, complications, and technology yield of 700 robotic frameless intracranial stereotactic biopsies conducted with the Remebot system.Method: This research considered 700 robotic biopsies performed between 2016 and 2020 by surgeons from the Department of Functional Neurosurgery in Beijing's Tiantan Hospital. The data collected included histological diagnoses, postoperative complications, operation times, and the accuracy of robotic manipulation.Results: Among the 700 surgeries, the positive rate of the biopsies was 98.2%. The most common histological diagnoses were gliomas, which accounted for 62.7% of cases (439/700), followed by lymphoma and germinoma, which accounted for 18.7% (131/700) and 7.6% (53/700). Bleeding was found in 14 patients (2%) by post-operation computed tomography scans. A total of 29 (4.14%) patients had clinical impairments after the operation, and 9 (1.29%) experienced epilepsy during the operation. The post-biopsy mortality rate was 0.43%. Operation time—from marking the cranial point to suturing the skin—was 16.78 ± 3.31 min (range 12–26 min). The target error was 1.13 ± 0.30 mm, and the entry point error was 0.99 ± 0.24 mm.Conclusion: A robot-assisted frameless intracranial stereotactic biopsy guided by a videometric tracker is an efficient, safe, and accurate method for biopsies.

A Comparation Between Frame-Based and Robot-Assisted in Stereotactic Biopsy

“…The operation time for robot-assisted biopsies reported in our study is consistent with the literature ( 3 , 27 ). Compared with traditional stereotactic biopsy, the operation time was shorter with robot-assisted biopsy attributed to the fact that robot-assisted stereotactic biopsy only required importing data of the designed trajectory into the operating platform.…”

“…Stereotactic brain biopsy is well-established as a safe and effective way to diagnose brain occupying lesions that can assist in the diagnostic workup to ensure that patients receive optimal therapy ( 3 , 8 , 16 ). Frame-based stereotactic biopsy has long been the gold standard for diagnosing intracranial lesions ( 17 , 18 ).…”

“…Overwhelmng evidence substantiates that robotic technology has very high accuracy. Liu et al ( 3 ) reported an entry point error of 0.99 ± 0.24 mm (ranging from 0.56 to 1.73 mm) and target point error of 1.13 ± 0.30 mm (ranging from 0.57 to 1.78 mm) after conducting 700 biopsy surgeries using the Remebot device. Dlaka et al ( 14 ) reported a target point error of 1.95 ± 1.11 mm and an entry point error of 1.42 ± 0.74 mm for 32 brain biopsies with RONNA G4 system.…”

“…The main complication of stereotactic biopsy is hemorrhage, with a reported incidence ranging from 0 to 14.6% ( 3 , 10 , 18 , 26 – 28 , 34 ). Other complications include infection, neurologic deficits, and epilepsy ( 1 ).…”

“…In recent years, the diagnostic yield of intracranial lesions has substantially improved due to the development of neuroimaging (1). In clinical practice, tissue biopsy is often required to confirm the diagnosis and determine the treatment regimen given the heterogeneity surrounding clinical characteristics and imaging features (2)(3)(4). Frame-based stereotactic biopsy has long been the gold standard for diagnosing intracranial lesions due to its efficacy and safety (1,5,6).…”