Diagnostic yield and safety of Remebot robot-assisted stereotactic biopsy: a 496-case retrospective analysis of intracranial lesions.

Abstract

Objective: The aim of this study was to evaluate the diagnostic yield, safety, and workflow advantages of the Remebot system in intracranial stereotactic biopsies.

Methods: The authors retrospectively analyzed 496 consecutive patients who underwent Remebot-assisted stereotactic brain biopsy at a single institution between 2023 and 2024. Demographic, clinical, radiological, and pathological data were collected. Logistic regression analysis was used to identify predictors of nondiagnostic biopsy. Model performance was evaluated using McFadden's pseudo-R2 and receiver operating characteristic analysis. Perioperative complications were defined and graded according to the Common Terminology Criteria for Adverse Events (version 5.0).

Results: The overall diagnostic yield was 85.9% (426/496), with high-grade glioma (32.7%) and hematological malignancies (20.4%) as the most common pathologies. Multivariate analysis identified deep lesion sampling (OR 0.51, 95% CI 0.27-0.94; p = 0.034) and younger age (OR 0.98, 95% CI 0.97-0.99; p = 0.006) as independent predictors of nondiagnostic results. Sex, lesion location (supratentorial vs infratentorial), and brainstem involvement were not associated with yield. The perioperative complication rate was 1.8% (9/496), with hemorrhage accounting for 77.8% of events. All complications occurred in male patients, predominantly in those with high-grade glioma. The Remebot system demonstrated notable workflow advantages, including integrated planning, automated registration, and compact modular design.

Conclusions: Remebot-assisted stereotactic biopsy achieved a high diagnostic yield and low complication rate, comparable with that of international robotic platforms. Deep lesion sampling and younger age were found to increase the risk of nondiagnostic results, whereas sex and lesion location did not. The system's integrated workflow, automated registration, and cost-efficient accessibility broaden its clinical applicability and support its role as a reliable tool for minimally invasive neurosurgical diagnosis.