Safety, efficacy and efficiency of neurosurgical robots are defined by their design (i.e., framed and non-framed) and procedural workflow (from image to surgery). The present study describes the quality indicators of three different robots in brain and spine surgery. This single-center study enrolled 252 patients over a ten-years period. Safety (complication rate) and efficacy (diagnostic yield, pedicle screw placement) were determined. Predictors of workflow efficiency (e.g., skin-to-skin)

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... evaluated and compared to conventional techniques (neuronavigation, stereotaxy). All robots showed excellent reliability (97.5-100%) with low complication rates (4.5-5.3%) and high efficacy (94.7-97.7%). Robotics demonstrated a better time-efficiency than neuronavigation. However, there was no shortening of surgery time compared to conventional stereotaxy. Time-efficiency differed significantly between framed and non-framed workflows. While all neurosurgical robots were reliable, safe and efficacious, there were significant differences in time-efficiency. Procedural workflows should be improved to increase the acceptance of robotics in neurosurgery. This article is protected by copyright. All rights reserved.