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Surgery using an automated, robotic drill
May 15, 2017, 5:24 pm
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A computer-driven automated drill can make a complex cranial surgery 50 times faster than standard procedures, decreasing the time needed for the operation from two hours to a mere two and a half minutes.

Researchers at the University of Utah in the US developed the drill that produces fast, clean, and safe cuts, reducing the time the wound is open and the patient is anesthetized, thereby decreasing the incidence of infection, human error, and surgical cost.

To perform complex surgeries, especially cranial surgeries, surgeons typically use hand drills to make intricate openings, adding hours to a procedure. The need for a device that could alleviate this burden and make the process more efficient was what motivated the researchers. "We knew the technology was already available in the machine world, but no one ever applied it to medical applications," said William Couldwell who led an interdisciplinary team at the university to bring the drill into reality.

The team developed the drill from scratch to meet the needs of the neurosurgical unit, as well as developed software that sets a safe cutting path.

First, the patient is imaged using a CT scan to gather bone data and identify the exact location of sensitive structures, such as nerves and major veins and arteries that must be avoided. Surgeons use this information to program the cutting path of the drill. The software lets the surgeon choose the optimum path from point A to point B. In addition, the surgeon can program safety barriers along the cutting path within 1 mm of sensitive structures. The drill does the heavy lifting by removing most of the bone, similar to a mill, accurately and rapidly.

The researchers applied their new drill to a particularly complex jigsaw-like shape in the skull that circumnavigates the ear. The surgery is performed thousands of times a year to expose slow-growing, benign tumors that form around the auditory nerves. This cut is not only difficult, the cutting path also must avoid several sensitive features, including facial nerves and the venous sinus, a large vein that drains blood from the brain. Risks of this surgery include loss of facial movement.

The device also has an automatic emergency shut-off switch. During surgery, the facial nerve is monitored for any signs of irritation. If the drill gets too close to the facial nerve and irritation is monitored, the drill automatically turns off.

The new automated drill not only performed the surgical operation flawlessly, but also did so in less than three minutes — a fraction of the more than two hours that it would have taken a surgeon to do it with a hand-drill.

The shorter surgery is expected to lower the chance of infection and improve post-operative recovery. It also has potential to substantially reduce the cost of surgery, because it shaves hours from operating room time.

The research team says their drill can be adapted for a variety of surgeries and could lower the cost of health care so that more people can receive quality care, said Couldwell.

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