Use of robotic surgery in the revolution of minimally invasive surgery in neurosurgery: advances and challenges

Abstract

Advances in minimally invasive surgery have been driven by the integration of navigation and robotic technologies, bringing significant improvements in fields such as neurosurgery and orthopedics. From the rudimentary methods described by Hippocrates to the introduction of modern systems like cone beam computed tomography (CBCT) and robotic devices, the focus has been on enhancing precision, safety, and procedural efficiency. Hybrid operating rooms, combining navigation and robotics, represent a milestone in modern medicine, enabling less invasive interventions and better clinical outcomes, especially in complex conditions like spinal trauma and tumors. This systematic review investigated the advances, challenges, and clinical impact of robotic surgery in minimally invasive neurosurgical procedures. Studies from the past two decades were analyzed, prioritizing those addressing surgical precision, safety, and clinical outcomes in complex procedures such as pedicle screw placement and tumor resections. Additionally, challenges such as cost, learning curve, and technology accessibility were evaluated, highlighting existing gaps in the literature and the need for broader studies. The results demonstrated the high efficacy and safety of robotics, with accuracy rates exceeding 97% in implant placement and low complication rates. Technologies like 3D navigation and robotic arms have transformed surgical approaches, enabling less invasive procedures, fewer postoperative complications, and shorter recovery times. However, further investigation into the long-term impacts and cost-effectiveness of these innovations is needed to establish their application as the standard in neurosurgery and expand their impact to a broader patient population. The results of this review highlight the undeniable benefits of integrating navigation and robotics into minimally invasive surgeries, showing significant advancements in precision, safety, and efficiency. With success rates exceeding 97% in applications such as pedicle screw placement and tumor resections, these technologies are transforming surgical practice, particularly in neurosurgery, by reducing complications and accelerating patient recovery. Despite these advances, the review also points to significant gaps in the literature, such as the need for larger, controlled studies to assess long-term impacts, cost-effectiveness, and challenges related to the learning curve and technological accessibility. The continued evolution of these innovations requires a collaborative approach based on solid evidence to overcome these challenges. It is concluded that navigation and robotics represent a milestone in the advancement of minimally invasive surgeries, with the potential to become standards in neurosurgery and other specialties. However, their successful implementation depends on future investigations that consolidate their role and expand their applicability, benefiting an increasing number of patients and ensuring better clinical outcomes.