AbstractBackgroundSafety, efficacy and efficiency of neurosurgical robots are defined by their design (i.e., framed and non‐framed) and procedural workflow (PW) (from image to surgery). The present study describes the quality indicators of three different robots in brain and spine surgery.MethodsThis single‐centre study enrolled 252 patients over a 10‐year period. Safety (complication rate) and efficacy (diagnostic yield, pedicle screw placement) were determined. Predictors of workflow efficiency (e.g., skin‐to‐skin) were evaluated and compared to conventional techniques (neuronavigation, stereotaxy).ResultsAll robots showed excellent reliability (97.5%–100%) with low complication rates (4.5%–5.3%) and high efficacy (94.7%–97.7%). Robotics demonstrated a better time‐efficiency than neuronavigation. However, there was no shortening of surgery time compared to conventional stereotaxy. Time‐efficiency differed significantly between framed and non‐framed workflows.ConclusionWhile all neurosurgical robots were reliable, safe and efficacious, there were significant differences in time‐efficiency. PWs should be improved to increase the acceptance of robotics in neurosurgery.
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