Clinical application of the da Vinci Xi robotic system for open intracranial tumour resection

The intracranial environment has long resisted robotic adoption because of specific and well-characterized practical barriers that differ from those encountered in abdominal and pelvic surgery. Here, to our knowledge, we report the first published clinical application of the da Vinci Xi Surgical System for open brain tumour removal. A 68-year-old man with a 25 × 15 mm contrast-enhancing, right frontal, dural-based lesion underwent robot-assisted right frontal craniotomy. The total operative time was 2 hours and 45 minutes. There were no intraoperative complications, and the patient was neurologically intact at discharge on postoperative day 2. Neuropathological assessment confirmed an atypical meningioma, WHO Grade 2, while surveillance MRI at 3 months identified no residual or recurrent enhancing tissue. The seven-degree-of-freedom (7-DOF) EndoWrist articulation, integrated tremor filtration, and high-definition stereoscopic visualization offered measurable operative benefit along the tumour margin, where the geometrical constraints of the working corridor would have required greater cortical retraction under conventional microsurgical conditions. However, the 8-mm instrument shaft diameter meant that the craniotomy had to be designed around the instruments rather than the lesion, while the complete absence of haptic feedback meant that tissue dissection relied entirely on visual cues, potentially limiting the system’s use in more complex operative settings. This case establishes the technical feasibility of da Vinci Xi-assisted open intracranial tumour resection but does not demonstrate superiority over experienced microsurgical technique. Further development, particularly instrument downsizing and integration of tactile feedback, will be required before the approach can be evaluated more broadly beyond proof-of-concept.