Application of robot-assisted full-course visualized hematoma puncture, aspiration and drainage in basal ganglia intracerebral hemorrhage: a comparative study with robot-assisted surgery and neuroendoscopic surgery

Abstract Background We aimed to investigate the clinical effectiveness and application value of robot-assisted full-course endoscopic visualized hematoma puncture, aspiration, and drainage in treating patients with basal ganglia intracerebral hemorrhage (ICH) with a hematoma volume of 30–60 mL. A comparative analysis was performed between conventional robot-assisted hematoma puncture and neuroendoscopic hematoma evacuation. Methods A retrospective analysis was conducted on 68 patients with basal ganglia ICH admitted between January 2025 and September 2025. Patients were assigned to three groups based on the surgical approach: the visualization group ( n = 16, treated with robot-assisted full-course endoscopic visualized hematoma puncture, aspiration, and drainage), the robot group ( n = 28, treated with robot-assisted hematoma puncture, aspiration, and drainage), and the endoscopic group ( n = 24, treated with neuroendoscopic hematoma evacuation). The baseline clinical characteristics, surgical parameters, postoperative complications, and long-term prognosis were compared among the three groups. Results No statistically significant differences were detected in baseline characteristics, including age, sex, timing of surgery (from onset to surgery), admission Glasgow Coma Scale score, preoperative hematoma volume, and prevalence of hypertension and diabetes, indicating good baseline comparability. Compared with the robot group, the visualization group had a slightly longer operation time, but the 1-d postoperative hematoma clearance rate was significantly higher (79.44 ± 7.82% vs. 73.46 ± 9.53%, P = 0.031). Relative to the endoscopic group, the visualization group showed markedly shorter operation time (37.75 ± 5.34 min vs. 148.96 ± 18.12 min), lower rate of intraoperative blood loss ≥ 50 mL (6.3% vs. 79.2%), shorter hospital stay (12.88 ± 3.88 d vs. 18.08 ± 4.70 d) and lower hospitalization cost (48.7 ± 14.3 thousand CNY vs. 75.7 ± 21.0 thousand CNY), with all differences statistically significant (all P < 0.001). The visualization group also exhibited a lower incidence of postoperative complications and a trend toward better prognostic indicators, although these differences were not statistically significant. The learning curve of the visualization group reached an inflection point in the eighth case, with the surgical indicators stabilizing thereafter. Conclusion This novel minimally invasive technique integrates the advantages of precise robotic stereotactic navigation and endoscopic real-time visualization. This approach provides a new optional scheme for minimally invasive treatment of basal ganglia ICH.