Objective To compare the advantages of percutaneous robot assisted puncture localization with freehand puncture localization in endoscopic spinal surgery. Methods A retrospective analysis was performed on 62 patients who underwent percutaneous intervertebral foraminoscopic excision of intervetebral disk herniation from March 2022 to June 2022.The included patients were all single level herniation of L4~5.Combined with easy technique (Easy-T) operation localization method,all patients were operated through posterolateral approach.Thirty patients were randomly divided into two groups,including 21 males and 9 females,aged 19~72 years,with an average age of (45.2±16.7) years.The other 32 patients underwent freehand puncture positioning (routine group),including 17 males and 15 females,aged 23~68 years,with an average age of (47.6±19.5) years.The number of intraoperative fluoroscopy,the amount of blood loss,the operation time and the pain visual analogue scale before,1 day,1 week,1 month and 3 months after surgery were recorded in the two groups.Oswestry disability index (ODI),and the Japanese orthopaedic association (JOA) score were recorded for intraoperative and postoperative complications.Results All patients successfully completed the operation,the follow-up time was 3~6 months,and the mean follow-up time was (4.6±2.1) months.The number of intraoperative fluoroscopy,operation time and bleeding time in the robot group were less than those in the conventional group,and the differences were statistically significant (P<0.05).At 1 day,1 week,1 month and 3 months after surgery,VAS score,ODI score and JOA score of 2 groups were improved compared with those before surgery,and the differences were statistically significant (P<0.05).There were no significant differences in VAS score,JOA score and ODI score between 2 groups before surgery and 1 day,1 week,1 month and 3 months after surgery (P>0.05).Conclusion Both groups of patients can obtain long-term satisfactory results after surgery.However,compared with hands-free puncture positioning,robot-assisted puncture positioning has fewer fluoroscopy times,less blood loss,and shorter operation time.Moreover,preoperative imaging planning is not required under robotassisted puncture,which can combine with Easy T positioning method,make puncture targets more accurate and ideal,retain more healthy tissues during the operation,and highlight the concept of minimally invasive.