{
  "abstract": "Objective: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Technical University Hospital of Munich, TUM School of Medicine and Health, Munich, Germany",
    "Department of diagnostic and interventional Neuroradiology, Technical University Hospital of Munich, TUM School of Medicine and Health, Munich, Germany",
    "Department of Pathology and Neuropathology, Technical University Hospital of Munich, TUM School of Medicine and Health, Munich, Germany"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Carolin Albrecht"
    },
    {
      "affs": [
        1
      ],
      "name": "Tobias Mahler"
    },
    {
      "affs": [
        2
      ],
      "name": "Viktor M. Eisenkolb"
    },
    {
      "name": "Benedikt Wiestler"
    },
    {
      "name": "Claire Delbridge"
    },
    {
      "name": "Chiara Negwer"
    },
    {
      "name": "Bernhard Meyer"
    },
    {
      "name": "Arthur Wagner"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1v7bfxbf9kk81.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0362271",
  "fulltext_url": null,
  "id": "1v7bfxbf9kk81",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0362271",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "plos",
      "/Engineering and technology/Mechanical engineering/Robotics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Clinical oncology/Surgical oncology"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Hemorrhage"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Lesions"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health care providers/Physicians/Surgeons"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer treatment/Surgical oncology"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Clinical oncology/Surgical oncology"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Biopsy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Robotic assisted surgery"
    ],
    [
      "plos",
      "/Medicine and health sciences/Vascular medicine/Hemorrhage"
    ],
    [
      "plos",
      "/People and places/Population groupings/Professions/Medical personnel/Physicians/Surgeons"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/1v7bfxbf9kk81.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:20:42Z",
      "native_id": "10.1371/journal.pone.0362271",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0362271"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:oncology",
      "subfield": "oncology"
    },
    {
      "field": "medicine",
      "origin": "plos:surgical and invasive medical procedures",
      "subfield": "surgery"
    }
  ],
  "title": "The impact of robot-assisted frameless brain biopsy on performance differences between junior and senior neurosurgeons",
  "title_text": "The impact of robot-assisted frameless brain biopsy on performance differences between junior and senior neurosurgeons",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:24Z",
  "url": "https://research.draconitic.com/paper/1v7bfxbf9kk81",
  "venue": "PLOS One",
  "versions": []
}