Robotic drill developed for cranial surgery

The paths of technology and science are by now very much interwoven, and ever more regularly groundbreaking research is producing some really forward-thinking innovations. We’re a world away (thankfully) from the rustic medical techniques of days gone by, and well on the path to making quality healthcare accessible for all - but there are some areas of surgery where cost and risk remains prohibitive for many patients.

Operations on the brain involve cutting into the skull and particularly call for extremely delicate surgical techniques. These techniques tend to be complex, invasive, time-consuming and costly, and researchers in the states are looking at ways to develop ‘a low-cost drill that could do a lot of the grunt work’ to speed up and simplify such procedures, thus bringing down costs and making safer treatment a more realistic option.

A team of staff at the USA’s University of Utah Health have developed an advanced new computer-aided automated drill system that could turn complex brain surgeries lasting hours into simpler, safer procedures lasting just minutes. The drill produces clean cuts that require being open for far less time than cuts made manually, reducing the risk of infection, and the computer assisted technology will help to reduce human error and surgical costs.

In complex brain surgery, surgeons currently use a miniature type of hand drill to saw through the skull, making intricate openings using manual dexterity. This would add hours onto surgery times. “It was like doing archaeology. We had to take away the bone slowly to avoid sensitive structures.” says William Couldwell, a neurosurgeon at University of Utah Health.

Couldwell led an inter-disciplinary team of staff at the university to begin developing the drill, the technology for which had already existed in the world of machining. He saw a need for a device that could alleviate the burden on surgeons and the risk to patients, and make the process more efficient. “We knew the technology was already available in the machine world, but no one ever applied it to medical applications.”

So, how does it work? Initially, the patient is imaged using a series of CT scans that help the surgeons to establish the unique shape of the skull. These scans also pinpoint the location of important structures including the venous sinus, the main vein from the brain, and sensitive facial nerves. Surgeons then program this information into a computer, which comes up with a safe and simple cutting path that avoids sensitive structures by a protective margin of up to 1mm. “The software lets the surgeon choose the optimum path from point A to point B, like Google Maps,” said A.K. Balaji, associate professor of mechanical engineering at the university. “Think of the [1mm] barriers like a construction zone. You can slow down to navigate it safely.”

But exactly how precise can such a piece of equipment be? Developers tested the drill’s precision by applying it to the translabyrinthine opening, a complex piece of bone behind the ear that’s hard and jigsaw-shaped. Surgery on this area is currently performed thousands of times a year, as the translabyrinthine opening provides access to benign tumours that commonly grow around the auditory nerves in this area. The troublesome shape and texture of the bone make this particular area a great location for testing the new drill. “It’s like Monster Garage, except instead of machining a part, we’re machining the skull,” Couldwell says.

It sounds a bit more complex than Monster Garage (to us, anyway), but that a computer-aided drill can successfully perform this complex cut is a really exciting development. After having tested the safety and speed of the drill, Couldwell and the team stress that this method can potentially be applied to many other surgical procedures, such as “machining the perfect receptacle opening in the bone for a hip implant”.

Safer, more affordable surgeries worldwide are a priority for medical equipment developers, and employing technology to assist with the burden on patients and surgeons alike is a prime example of how computers can work alongside humans to maximum effect. Here’s to the next exciting development from the University of Utah Health!

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