The Future of Brain Surgery Might Be This Automated Drill

A computer-driven drill system developed at the University of Utah can potentially reduce a two-hour procedure to just over two minutes.

With widespread anxiety about automation and its impact on jobs, some might say we need another robot like we need a hole in the head.

Yeah, about that...

A new medical robot developed at the University of Utah might be used in future cranial surgeries, replacing human surgeons in at least one critical part of the operation. The robotic drill is said to be 50 times faster — and almost certainly a lot safer — at the delicate and time-consuming task of cutting holes in a human skull.

In most cranial surgeries, doctors use hand drills to make carefully placed openings in the skull. The procedure is not that different from using a hand drill in a workshop setting. The surgeon bores through the skull using a milling drill bit, avoiding sensitive nerves and blood vessels.

Making the opening can take hours, even for an experienced surgeon. The more time a procedure takes, the greater the risk of infection, complications from anesthesia, or surgeon fatigue.

The new automated cranial drill system can reduce that time from hours to minutes, according to the research team. In fact, testing showed that the robot surgeon regularly completed a standard two-hour surgical procedure in two-and-a-half minutes.

The findings were published in the May 1 issue of the online journal Neurosurgical Focus.

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To be clear, the testing was not done in actual surgical settings, said A. K. Balaji, associate professor in mechanical engineering at the University of Utah.

“The system has been tested in a variety of materials ranging from wax, composites, engineered cancellous and cortical bone, prototyped skulls, and human cadavers,” Balaji said in an email. “All procedures were based on imaging the specimens and then producing an automated tool path.”

That's where the human expertise comes in. Well before the patient is brought in for surgery, the medical team analyzes CT scans and other assessments to identify the exact locations of nerves and major veins and arteries. The analysis also gives surgeons relevant data on the composition and density of the bone. From there, surgeons directly program the cutting path of the drill from beginning to end.

"The software lets the surgeon choose the optimum path from point A to point B, like Google Maps," said Balaji. The surgeon can also program safety barriers along the cutting path within 1 millimeter of sensitive structures. If the drill gets too close, an automatic kill switch is engaged. Hmm, “kill switch” is probably the wrong term. Let's say “shut-off switch.”

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William Couldwell, a neurosurgeon at the University of Utah, led the interdisciplinary design team that developed the surgical drill. He said he hopes to see the drill system in clinics within two years, for both cranial surgeries and other procedures.

"This drill can be used for a variety of surgeries, like machining the perfect receptacle opening in the bone for a hip implant," he said.

Historians may want to note, then, that in May of 2017 we taught robots how to drill into our hips — and skulls.

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