Background: In frame-based stereotaxy, the design of the frame limits trajectory selection, e.g., to the temporal lobe and posterior fossa. We hypothesise that frame-less neuronavigation and robotic technology might have expanded these stereotactic corridors.
Methods: We analysed 376 frame-based, neuronavigated and robotic brain biopsies. We analysed entry (EP) and target (TP) point coordinates, trajectory lengths (TL) and angles (α1,α2), skin-to-skin time (STS), diagnostic yield and morbidity.
Results: Robotics liberated TP and EP selection, enabling trajectories not applicable with the frame. There was an increased application of lateral trajectories (reducing α1) while decreasing TL. There was a significant STS reduction attributable to a modification of the surgical approach (twist drill vs. burr hole).
Conclusions: Robotics modified trajectory selection and the surgical approach. Duration and invasiveness of brain biopsies were decreased without affecting diagnostic yield or morbidity. This may represent a clinical benefit of robotics compared with frame-based and frame-less stereotaxy.
Keywords: brain biopsy; frame‐less stereotactic surgery; robotics; robot‐assisted surgery; stereotaxy.
© 2025 The Author(s). The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.