Precision in motion: the first UK published experience with Stealth Autoguide robotic stereotactic brain biopsy

BACKGROUND: Histopathological confirmation remains the gold standard for diagnosis and treatment planning in brain tumours. Frame-based stereotactic biopsy has traditionally been the standard approach, but advances in frameless neuronavigation and robotic assistance have improved procedural accuracy, efficiency, and patient comfort. The Stealth Autoguide robotic platform integrates with existing navigation systems to provide precise trajectory alignment. OBJECTIVE: To evaluate the reliability, feasibility, diagnostic yield, and safety profile of the Stealth Autoguide system for stereotactic biopsy of brain lesions in a tertiary neurosurgical centre. METHODS: A retrospective analysis was conducted of all patients undergoing Stealth Autoguide-assisted biopsy at Salford Royal Hospital, UK, between September 2023 and July 2025. Data collected included demographics, lesion characteristics, use of advanced imaging, operative details, histopathology, complications, and length of stay. RESULTS: Twenty-seven patients (19 male, 8 female; mean age 58 years, range 28-82) underwent robotic-assisted biopsy. Diagnostic yield was 100%. Glioblastoma (WHO Grade 4) accounted for 62.9% of diagnoses, followed by lymphoma (29.6%). No patient experienced postoperative haemorrhage requiring intervention, new neurological deficit, or procedure-related mortality. CONCLUSION: Stealth Autoguide-assisted biopsy is a safe, accurate, and efficient method for diagnosing deep-seated and surgically challenging brain tumours. In our initial UK experience, the system demonstrated excellent diagnostic yield and an outstanding safety profile, supporting its integration into routine neuro-oncological practice.