Comparative Analysis of the ROSA Robot Accuracy for the Placement of Laser Interstitial Thermal Therapy Probes

Laser thermal therapy (LITT) is a minimally invasive treatment for intracranial lesions with success dependent on precise placement of the laser probe. The Robotic Surgical Assistant (ROSA) ONE Brain robotic platform is one stereotactic method that is used to aid this process. This study examined the accuracy of LITT probe placement utilizing the ROSA robot, comparing entry distance, target distance, and entry angle errors across two major LITT platforms: Neuroblate (Monteris Medical) and Visualase Systems. A prospective review of patients who underwent LITT from 2013 to 2023 with the ROSA was performed. Statistical analyses were performed with the sign test, Spearman correlation, and Kruskal-allis test. Of 105 patients, 337 probes were placed. For Visualase probes, median entry distance was 1.1 mm (IQR 0.4-2.0), target distance 1.6 mm (IQR 0.9-2.4), and entry angle error 1.5° (IQR 0.9-2.5°), all significantly different from zero (P<0.0001). For Neuroblate probes, the corresponding values were 1.5mm (IQR 1.0-2.1), 1.8mm (IQR 1.1-2.4), and 1.8° (IQR 1.1-2.5°), also significantly different from zero (P<0.0001). A negative correlation was found between entry angle error and trajectory length for both systems (P<0.0001). In conclusion, while the ROSA robotic system aids in LITT probe placement, it does not achieve perfect alignment. Longer trajectory lengths were associated with reduced entry angle errors.