Robot-assisted percutaneous pelvic channel screw placement for unstable pelvic ring injuries: a systematic review and meta-analysis with narrative technical comparison of multi-platform differences

Clinical Snapshot

Key Findings

• P Value: p < 0.001

• Effect Size: OR = 5.32 for improved accuracy with robot assistance

• Primary Outcome: Screw accuracy (excellent/good rate): 98.2% robot-assisted vs 86.4% conventional

• Nnt Or Sensitivity: NNT = 9 patients (calculated from 11.8% absolute risk reduction in poor screw placement)

• Confidence Interval: 95% CI: 3.18-8.89

Clinical Application

Limited by high acquisition costs, training requirements, and availability of robotic systems in trauma centres Relevant for major trauma centres; TGA approval status unclear for pelvic trauma applications; cost-effectiveness analysis needed for PBS consideration Adult patients with unstable pelvic ring injuries requiring percutaneous screw fixation in centres with robotic capability

Abstract

Percutaneous pelvic channel screw fixation is a key technique for the minimally invasive treatment of pelvic ring injuries. Robotic-assisted systems aim to improve accuracy and reduce radiation, but direct comparative studies across platforms are lacking. This systematic review and meta-analysis primarily compares robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement, with a secondary narrative comparison of technical differences across TiRobot, Mazor X, and ROSA platforms. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, and CBM databases up to April 2026. Comparative studies of robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement in adult pelvic ring injury patients were included. Primary outcomes were screw accuracy (Gras classification) and radiation exposure. Secondary outcomes included operative time, functional recovery (Majeed score), complications, and cost. No direct head-to-head studies comparing different robotic platforms for pelvic screw placement were identified; therefore, platform comparisons are primarily narrative and indirect, with spine surgery data presented as hypothesis-generating only. Risk of bias was assessed using ROBINS-I and RoB-2, and evidence was graded using the GRADE system. Fifteen studies (1,247 patients, 2,893 screws) were included. Primary meta-analysis showed that robot-assisted placement significantly improved screw accuracy (excellent/good rate: 98.2% vs. 86.4%; OR = 5.32, 95%CI: 3.18-8.89, p < 0.001; GRADE: Low certainty due to risk of bias) and reduced radiation exposure (SMD=-1.84, 95%CI: -2.43 to -1.25; GRADE: Low certainty due to serious inconsistency). Operative time showed no significant difference in studies by experienced surgeons (MD=-5.2 min, 95%CI: -11.0 to 0.6). Functional outcomes (Majeed score) were comparable between groups (MD = 0.8, 95%CI: -0.7 to 2.3). Overall complications were significantly reduced with robotic assistance (OR = 0.46, 95%CI: 0.30-0.71; GRADE: Low certainty due to risk of bias). For platform comparisons, TiRobot has the strongest pelvic trauma-specific evidence from 11 studies (847 patients). Evidence for Mazor X and ROSA in pelvic trauma is limited to technical descriptions and indirect spine surgery data; no direct pelvic trauma validation is available. Robot-assisted pelvic channel screw placement is superior to conventional methods in accuracy and radiation reduction, with comparable functional outcomes and fewer complications. TiRobot demonstrates the strongest pelvic trauma-specific evidence based on available comparative studies. Mazor X and ROSA require direct pelvic trauma validation before their performance can be reliably compared. TiRobot may have lower acquisition costs in Chinese healthcare settings, but formal cost-effectiveness analyses are lacking for all platforms. Significant evidence gaps remain, including lack of high-quality RCTs, absence of direct platform comparisons in pelvic trauma, and insufficient cost-effectiveness analyses.

References

1. 1.Zhang, W., Zhang, J., Guo, Z., Yu, J., Yang, Y., Zhang, H., Ma, G., Chen, J., & Tai, H. (2026). Robot-assisted percutaneous pelvic channel screw placement for unstable pelvic ring injuries: a systematic review and meta-analysis with narrative technical comparison of multi-platform differences. Journal of Robotic Surgery. https://doi.org/10.3389/fsurg.2025.1594928