Clinical benefits of robotics in neurosurgery: a systematic review of operative time and recovery outcomes

Abstract Background Robotic assistance in neurosurgery has emerged as a promising tool to enhance surgical precision, reduce intraoperative variability, and improve recovery outcomes. However, the clinical benefits of these systems remain under ongoing evaluation. Objective To systematically assess the impact of robotic-assisted neurosurgical procedures on operative time, accuracy, and postoperative recovery. Methods A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched for studies published between January 2020 and December 2024. Eligible articles included human subjects undergoing robotic-assisted neurosurgery with reported outcomes on operative duration or recovery. Two independent reviewers performed screening, data extraction, and risk of bias assessment. Results From 1138 records screened, 28 original studies met inclusion criteria. Robotic platforms were applied in stereotactic, spinal, and other cranial procedures. Sixteen studies (57.1%) reported operative time, with most showing reductions using robotics. Accuracy was consistently high, with target point errors between 1.1 and 2.1 mm and pedicle screw accuracy above 95%. Thirteen studies (46.4%) reported shorter hospital stays and faster recovery with robotic guidance. Functional outcomes improved in procedures such as deep brain stimulation and spinal fusion. Conclusion Robotic-assisted neurosurgery suggests benefits regarding reduced operative time, enhanced accuracy, and improved recovery in selected procedures. These findings support the continued evaluation of robotics in neurosurgical workflows, though further high-quality studies are needed to definitively establish cost-effectiveness and long-term superiority over conventional methods.