Comparison of accuracy, efficiency and safety between robotic-assisted and non-robotic-assisted deep brain stimulation: systematic review and/or meta-analysis

Objective:This meta-analysis aims to compare robotic-assisted deep brain stimulation (RA-DBS) and non-robotic-assisted deep brain stimulation (nRA-DBS) regarding accuracy, efficiency and safety.Methods:We searched six databases to retrieve relevant studies. Two independent reviewers selected the studies and assessed the risk of bias using the Cochrane risk-of-bias tool for randomized trials version 2 and the Methodological index for nonrandomized studies score. Statistical analysis was completed by Revman 5.4.Results:A total of seven trials with 341 participants entered our analysis. Our meta-analysis showed that RA-DBS demonstrated a statistically significant reduction in target point error (MD: -0.30, 95%CI: [-0.58, -0.02], I2 = 0, P = 0.03) and deviation outliers compared to nRA-DBS. (OR: 0.15, 95%CI: [0.04, 0.51], I2 = 0, P = 0.002). RA-DBS and nRA-DBS demonstrated comparable efficiency metrics in terms of operation room time (MD: 19.37, 95%CI: [-62.85,102.59], I2 = 99%, P = 0.65), operating time (MD: -17.04, 95%CI: [-84.95, 50.87], I2 = 98%, P = 0.62) and total anesthesia time (MD: 14.24, 95%CI: [-96.26, -124.73], I2 = 97%, P = 0.80). Two groups were comparable in terms of complication rates (OR: 1.79, 95%CI: [0.79, 4.05], I2 = 5%, P = 0.17) and intracranial hemorrhage rates (OR: 0.80, 95%CI: [0.23, 2.74], I2 = 0, P = 0.72).Conclusions:RA-DBS exhibits efficiency and safety comparable to nRA-DBS, serving as a viable alternative to nRA-DBS. Although RA-DBS shows promise in accuracy, further high-quality studies are needed to establish its clinical superiority.