Accuracy and safety of deep brain stimulation assisted by a neurosurgical robot attachable to the operating table

Objective: Neurosurgical robots have recently been introduced to assist in guiding trajectories to achieve accurate targeting. This study investigated the accuracy of robot-assisted deep brain stimulation (DBS) compared with conventional DBS using the Leksell arc system.Methods: Between October 2020 and September 2021, 29 patients underwent DBS using the Leksell arc system, while from October 2021 to August 2022, 20 patients underwent DBS using a neurosurgical robot system (KYMERO; Koh Young Technology). Radial errors, total operative time (surgery time, preparation time), and clinical outcomes were compared between both groups through a retrospective analysis. Results: Radial errors were significantly smaller in robot-assisted DBS (1.63±0.39 mm vs. 1.01±0.39 mm, p<0.01). Furthermore, the error of the second implantation was smaller than in the Leksell DBS group (0.216 vs. 0.005 mm, p<0.001). The total operative time of DBS with Leksell frame was 3.47 hours (range, 2.38-5.85 hours) and the surgery time was 2.21 hours (range, 1.08-4.67 hours), while the total operative time in the robot group was 3.92 hours (range, 2.75-5.85 hours) and the surgical time was 2.60 hours (range, 1.02-4.67 hours) (p=0.055, p=0.258, respectively). The clinical outcome did not show a significant difference according to the surgical method.Conclusion: DBS with a robot-assisted system enables the accurate and consistent insertion of DBS electrodes with a lower error rate than the conventional method.