Robert Harutyunyan, Joudy Charbaji, Ruxandra Penta, Sean D Jeffries, Joshua Morse, Thomas M Hemmerling
Percutaneous needle placement is ubiquitous across specialties, yet accuracy remains constrained by needle-tissue interactions and target localization, motivating interest in robotic assistance. However, clinical benefit has yet to be systematically pooled. Following PRISMA guidelines with prospective registration (PROSPERO-CRD420251052285), PubMed, Embase (Ovid), Cochrane CENTRAL, and Scopus were systematically searched through July 22nd, 2026. Comparative studies of robotic, semi-robotic or co-manipulated needle systems versus manual technique were eligible and analyzed as separate streams: clinical (patients) and preclinical (animal, cadaveric, benchtop). Outcomes included procedure time, needle accuracy, success rate, and complication rate. Random-effects meta-analyses were performed using standardized mean differences (SMD) and odds ratios (OR) with pre-specified subgroup analyses. Forty studies were included, 14 clinical (834 patients) and 26 preclinical. Clinically, procedure time (SMD - 0.40; 95% CI -1.15 to 0.36; P = 0.30), procedural success (OR 0.69; 0.17 to 2.77; P = 0.60) and complications were not statistically significant (OR 0.73; 0.46 to 1.16; P = 0.18), while needle accuracy favored robotic systems (SMD - 0.71; -1.06 to -0.36; P < 0.0001). Preclinically, procedure time was not significant (SMD 0.63; -0.14 to 1.41), while needle accuracy (SMD - 1.09; -1.67 to -0.51) and technical success (OR 2.76; 1.25 to 6.12) favored robotic systems. Certainty was low for clinical accuracy and complications, very low for procedure time and success. Robotic needle systems may modestly improve needle placement accuracy, without demonstrated effect on procedure time, procedural success or complications. Larger preclinical effects establish technical validity rather than a clinical indication. Further randomized trials are needed to confirm real-world benefit of robotic assistance.