This is a fascinating piece of work by a Korean team developing a human-robot collaborative control. Their model uses image guidance surgery to locate the drill tip’s position. Important structures can be highlighted – in this case the facial nerve. As the drill tip gets closer to the chosen structure, the drill movements become stiffer to give the operator feedback, until it appears that the operator will breech the target structure at which the actuators block the drill movement completely and alarm.
The system was tested by allowing an engineer who was an untrained surgeon to drill five cadaveric temporal bones, who successfully avoided the nerve whilst damaging other structures.
At the moment only two structures can be highlighted for protection although it seems likely that this number will increase. Obviously it seems unlikely that this will protect the nerve in the middle ear. Whilst I’m naturally a bit dubious about robotics at the moment and it seems to me that little will obviate the need for hours of temporal bone training and close supervised live operating, this seems like an exciting and potentially hugely useful addition to the mastoid surgeon’s armamentarium.