The impact of robot-assisted frameless brain biopsy on performance differences between junior and senior neurosurgeons
Carolin Albrecht, Tobias Mahler, Viktor M. Eisenkolb, Benedikt Wiestler, Claire Delbridge, Chiara Negwer, Bernhard Meyer, Arthur WagnerObjective
Frameless stereotactic brain biopsy is a standardized and routinely performed neurosurgical procedure, frequently carried out by residents under supervision in academic centers. Robot-assisted (RA) guidance has been introduced to standardize workflow and reduce operator-dependent variability. This study investigates whether RA frameless biopsy reduces experience-related performance differences between residents and attending neurosurgeons compared with a manually operated frameless system (MFS).
Methods
We performed a retrospective, non-randomized cohort study of consecutive patients undergoing RA frameless stereotactic brain biopsy for intracranial lesions at a tertiary academic center between 2021 and 2025. Outcomes included perioperative complications, diagnostic yield, and operative time, stratified by surgeon experience level (residents vs. attendings). Results were compared with those of a cohort operated with a MFS.
Results
A total of 98 procedures were analyzed (49 RA, 49 MFS). Across the entire cohort, total operative time was longer with RA than with MFS (115.6 ± 34.1 vs. 97.9 ± 27.2 minutes; p = 0.0036), primarily due to longer setup times. Diagnostic yield and complication rates were comparable between systems. Importantly, subgroup analysis demonstrated that residents using RA achieved operative times, diagnostic yield, and complication rates comparable to attending surgeons. In the MFS cohort, total operative time did not differ significantly between residents and attendings.
Conclusions
RA-assisted biopsy was associated with comparable diagnostic accuracy and safety relative to MFS. Robotic assistance was associated with smaller observed differences in operative efficiency between residents and attending surgeons, suggesting a potential role in bridging experience-related performance differences during neurosurgical training.