• Domagoj Dlaka, Marko Švaco, Darko Chudy, Bojan Jerbić, Bojan Šekoranja, Filip Šuligoj, Josip Vidaković, Fadi Almahariq, Dominik Romić, and Marina Raguž.
• Marina Raguž, Department of Neurosurgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10 000 Zagreb, Croatia, marinaraguz@gmail.com.
• Croat. Med. J. 2021 Aug 31; 62 (4): 318-327.

AimsTo report the outcomes of robot-assisted brain biopsies performed using a novel RONNA G4 system. The system was developed by a research group from the Faculty of Mechanical Engineering and Naval Architecture and a team of neurosurgeons from Dubrava University Hospital, University of Zagreb School of Medicine.MethodsThis prospective study included 49 biopsies analyzed during one year: 23 robotic frameless and 26 frame-based Leksell stereotactic biopsies. We analyzed the presenting symptoms, tumor range and location, postoperative complications, pathohistological diagnosis, diagnostic yield, as well as operation and hospitalization duration. The target point error was calculated to assess the accuracy of the RONNA system.ResultsNo postoperative mortality, morbidity, or infections were observed. In the frameless robotic biopsy group, only one pathohistological diagnosis was inconclusive. Therefore, the diagnostic yield was 95.6% (22/23), similar to that of the framebased Leksell stereotactic biopsy group (95.1% or 25/26). The average target point error in the frameless robotic biopsy group was 2.15±1.22 mm (range 0.39-5.85).ConclusionThe RONNA G4 robotic system is a safe and accurate tool for brain biopsy, although further research warrants a larger patient sample, comparison with other robotic systems, and a systematic analysis of the entry and target point errors.

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