Efficacy of robot-assistant visualized minimally invasive aspiration (RAVMIA) for lobar intracerebral hemorrhage.

BACKGROUND

While the role of surgery in intracerebral hemorrhage (ICH) remains controversial, endoscopic surgery (ES) has demonstrated efficacy for lobar ICH in clinical trials. However, a key limitation of ES is the requisite centimeter-scale injury to normal cortical tissue. In contrast, our previously proposed robot-assisted visualized minimally invasive aspiration (RAVMIA) technique enables efficient evacuation of elliptical hematomas while causing minimal collateral tissue injury (approximately 5 mm). This study aims to evaluate the efficacy of RAVMIA for lobar ICH.

METHODS

The RAVMIA procedure entails robot-guided insertion of a 5-mm trocar along the hematoma's long axis, coupled with real-time contact-visible endoscopic monitoring of aspiration. Its efficacy was assessed by comparing 15 patients treated with RAVMIA to 16 historical ES controls.

RESULTS

No significant differences were observed in baseline characteristics between the two groups. RAVMIA achieved similar hematoma evacuation rates (86.0%[79.0%, 95.3%] vs. 92.3%[86.0%, 94.7%]; P = 0.189) but with a smaller scalp incision (1.33±0.46 cm vs. 6.59±1.30 cm; P < 0.001), smaller craniotomy (0.50 cm vs. 4.47±0.68 cm; P < 0.001), and shorter surgery time (25.0 [20.0, 30.0] min vs. 65.5 [58.5, 72.5] min; P < 0.001). This was associated with shorter ICU stay (3.0[2.0,4.0] days vs. 4.5[3.75,5.0] days; P = 0.002) and total hospital stay (11.0 [10.0,13.0] days vs. 13.0 [10.75,14.0] days; P = 0.010). While GCS and mRS improvements were similar, RAVMIA led to a superior reduction in NIHSS score (5 [4,6] vs. 4 [3, 5]; P = 0.006). No infections or deaths occurred in either group.

CONCLUSION

For lobar ICH, RAVMIA demonstrates comparable hematoma evacuation rates to ES while offering enhanced minimally invasive benefits. The observed functional outcomes, including mRS, were similar between groups, though these findings require confirmation in larger, adequately powered studies. The potential for improved cost-effectiveness, as suggested by shorter operative time and hospital stay, warrants formal evaluation.