RETRACTED ARTICLE: Pedal to the metal: accelerating intracerebral hemorrhage treatment with robotic-assisted surgery. A systematic review & meta-analysis of clinical effectiveness

Intracerebral hemorrhage (ICH) is a severe condition in vascular neurological surgery, often leading to high mortality and severe disability. Recent advancements in robotic-assisted (RA) systems, including ROSA, Remebot, and CAS-R-2, have shown promise in enhancing surgical precision and outcomes. This study aims to evaluate the effectiveness of RA systems in ICH surgery compared to conventional methods. This systematic review followed PRISMA 2020 guidelines. The inclusion criteria were peer-reviewed English language articles reporting on the use of RA systems for ICH surgery in humans. Data extraction focused on surgical time, mortality rates, neurological outcomes, complication rates, and economic effectiveness. Meta-analyses were performed using R software, employing a random effects model to account for variations between studies. Seventeen studies were included in the systematic review, with thirteen qualifying for the meta-analysis. The results demonstrated that RA systems significantly reduced surgery time (MD -86.2447 [-128.5111; -43.9782], p < 0.0001) and mortality at last follow-up (OR 0.3652 [0.1457; 0.9158], p = 0.0317). RA systems also improved neurological outcomes, with lower mean modified Rankin Scale (mRS) scores (MD -0.8063 [-1.0786; -0.5341], p < 0.0001) and higher Glasgow Outcome Scale (GOS) scores (MD 0.6792 [0.1599; 1.1985], p = 0.0104). Complications such as rebleeding, pulmonary infections, and intracranial infections were significantly reduced. Robot-assisted surgery may provide benefits in ICH surgery, by reducing surgery time, lowering rates of mortality, better neurological outcomes, and reduced complications. Currently, the published studies are highly prone to bias and many outcomes are very heterogenous. Additional research done on larger, more standardized studies is needed for the full ascertainment of such techniques in being integrated into normal clinical practice.