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

Abstract

Introduction: Frame-based stereotactic biopsy is well-established to play an essential role in neurosurgery. In recent years, different robotic devices have been introduced in neurosurgery centers. This study aimed to compare the SINO surgical robot-assisted frameless brain biopsy with standard frame-based stereotactic biopsy in terms of efficacy, accuracy and complications.

Methods: A retrospective analysis was performed on 151 consecutive patients who underwent stereotactic biopsy at Chongqing Sanbo Jiangling Hospital between August 2017 and December 2021. All patients were divided into the frame-based group (n = 47) and the SINO surgical robot-assisted group (n = 104). The data collected included clinical characteristics, diagnostic yield, operation times, accuracy, and postoperative complications.

Results: There was no significant difference in diagnostic yield between the frame-based group and the SINO surgical robot-assisted group (95.74 vs. 98.08%, p > 0.05). The mean operation time in the SINO surgical robot-assisted group was significantly shorter than in the frame-based group (29.36 ± 13.64 vs. 50.57 ± 41.08 min). The entry point error in the frame-based group was significantly higher than in the robot-assisted group [1.33 ± 0.40 mm (0.47-2.30) vs. 0.92 ± 0.27 mm (0.35-1.65), P < 0.001]. The target point error in the frame-based group was also significantly higher than in the robot-assisted group [1.63 ± 0.41 mm (0.74-2.65) vs. 1.10 ± 0.30 mm (0.69-2.03), P < 0.001]. Finally, there was no significant difference in postoperative complications between the two groups.

Conclusion: Robot-assisted brain biopsy becomes an increasingly mainstream tool in the neurosurgical procedure. The SINO surgical robot-assisted platform is as efficient, accurate and safe as standard frame-based stereotactic biopsy and provides a reasonable alternative to stereotactic biopsy in neurosurgery.

Keywords: SINO robot; brain biopsy; frameless stereotactic biopsy; intracranial lesions; robot-assisted surgery.

Figure 1

(A) The SINO surgical robot. (B,C) The robot for brain biopsy.

Figure 2

(A,B) Design the stereotactic trajectory on the Sinoplan software. (C) Three-dimensional (3D) visualization technology of craniocerebral vascular.

Figure 3

(A–C) Measurement of entry point error based on postoperative CT scanning. The red lines represent the biopsy trajectory planned preoperatively. Bone defects represent the actual biopsy trajectory of the operation. The EPEs are computed as the average of the measurement of the inner part, midpoint and outer part of the cranial bone. (D) The picture shows the measurement results of one of the patients. The EPEs were 0.48, 0.48, and 0.49 mm, respectively.

Figure 4

(A–C) Measurement of target point error based on postoperative CT scanning. The centers of the red circles represent the target points planned preoperatively. The TPEs are computed based on the errors from axial position, coronal position and sagittal position respectively. (D) The picture shows the measurement of one of the patients. And the TPEs were 0.52, 0.54, and 0.76 mm, respectively. The actual TPE was 1.07 mm.

Figure 5

(A,B) The EPE and TPE of robot-assisted group were significantly less than that of frame-based group. (C) There was a significant reduction in operation time ***means P < 0.001.