The impact of robot-assisted frameless brain biopsy on performance differences between junior and senior neurosurgeons
- 1Department of Neurosurgery, Technical University Hospital of Munich, TUM School of Medicine and Health, Munich, Germany
- 2Department of diagnostic and interventional Neuroradiology, Technical University Hospital of Munich, TUM School of Medicine and Health, Munich, Germany
- 3Department of Pathology and Neuropathology, Technical University Hospital of Munich, TUM School of Medicine and Health, Munich, Germany
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.
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BibTeX
@article{albrecht2026impact,
title = {{The impact of robot-assisted frameless brain biopsy on performance differences between junior and senior neurosurgeons}},
author = {Carolin Albrecht and Tobias Mahler and Viktor M. Eisenkolb and Benedikt Wiestler and Claire Delbridge and Chiara Negwer and Bernhard Meyer and Arthur Wagner},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0362271},
url = {https://doi.org/10.1371/journal.pone.0362271},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The impact of robot-assisted frameless brain biopsy on performance differences between junior and senior neurosurgeons
AU - Carolin Albrecht
AU - Tobias Mahler
AU - Viktor M. Eisenkolb
AU - Benedikt Wiestler
AU - Claire Delbridge
AU - Chiara Negwer
AU - Bernhard Meyer
AU - Arthur Wagner
PY - 2026
DA - 2026/11/05
JO - PLOS One
DO - 10.1371/journal.pone.0362271
UR - https://doi.org/10.1371/journal.pone.0362271
AB - 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.
SN - 1932-6203
ER -