Percutaneous Endoscopic Transforaminal Discectomy (PETD) has been widely used for minimally invasive treatment of lumbar disc herniation (LDH), and percutaneous disc target puncture has a steep learning curve and high radiation exposure. Proper technology grafting can improve the surgical procedure and clinical outcomes. The changes brought by grafting surgical robots into PETD are worth investigating. A retrospective analysis was performed on the information of patients who received PETD in our hospital from March 2019 to July 2020. A total of 102 of patients who received 2D-guided robot-assisted PETD were included in Group A, and 102 of patients who received C-arm fluoroscopy-guided bare-handed PETD were included in Group B. The number of punctures, number of fluoroscopies, operation duration, intraoperative anxiety score, complications, and visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, on Day 1 after operation and at the last follow-up visit of the two groups were compared. All 204 patients received successful operations. Group A received 1.20±0.42 punctures, 10.49±2.16 fluoroscopies and 60.69±5.63 minutes of operation, significantly fewer than the 4.84±1.94 punctures, 17.41±3.23 fluoroscopies and 71.19±5.11 minutes of operation of Group B (all P<0.05), and Group A had significantly lower intraoperative anxiety scores and incidence of complications than Group B (both P<0.05). Both groups had comparable VAS and ODI scores on Day 1 after operation and at the last follow-up visit, which were both significantly higher than those before operation (P<0.05). 2D-guided robot-assisted PETD can enable precise planning of the puncture path, make it easier for operators to complete targeted punctures at pathogenic targets, reduce the number of punctures and fluoroscopies, shorten the operation duration to optimize the operation process, and reduce complications and alleviate intraoperative anxiety for better clinical results. Therefore it mayb be a better choice to assist PETD.AJTR Copyright © 2022.