Pedal to the Metal: Accelerating Intracerebral Hemorrhage Treatment with Robotic-Assisted Surgery. A systematic review & meta-analysis of clinical effectiveness

Abstract

Introduction 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 drainage compared to conventional methods. Materials and 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. Results Fifteen studies were included in the systematic review, with eleven qualifying for the meta-analysis. The results demonstrated that RA systems significantly reduced surgery time (MD -94.94 minutes, 95% CI: -149.85 to -40.03, p <.01) and mortality at last follow-up (OR 0.37, 95% CI: 0.15 to 0.92, p = .032). RA systems also improved neurological outcomes, with lower mean modified Rankin Scale (mRS) scores (MD -0.81, 95% CI: -1.08 to -0.53, p <.01) and higher Glasgow Outcome Scale (GOS) scores (MD 0.68, 95% CI: 0.16 to 1.20, p <.01). Complications such as rebleeding, pulmonary infections, and intracranial infections were significantly reduced. Economic analysis showed lower overall treatment costs due to reduced hospital stays and fewer complications. Conclusions Robotic-assisted systems offer substantial benefits in the surgical management of ICH, including reduced surgery times, lower mortality rates, improved neurological outcomes, and fewer complications. Despite these promising results, further large-scale, multi-center randomized controlled trials are needed to validate these findings and standardize protocols for the use of RA systems in neurosurgery.