Jun 13, 2017


Announcer: These are the conversations happening inside health care that are going to transform health care. The Health Care Insider is on The Scope.

Interviewer: A robotic drill that can make complicated cranial surgical cuts in minutes compared to hours that it would take a skilled surgeon to do the same thing. It was a dream of neurosurgeon, Dr. William Couldwell. But how did it become a reality? Dr. Couldwell, I'd like to start out first of all with a brief overview of how this automated drill works, because I think it's nothing short of amazing how you've been able to take something that used to take you, a skilled surgeon, two and a half hours to do and reduce that to two minutes. So kind of explain some of the working parts of this drill.

Skull Base Surgery

Dr. Couldwell: The whole notion for this drill was really conceived of by myself and Dr. McDonald, my partner, some years ago, and we do complicated skull base surgery and this base of the skull is important because it's the area where all the nerves and the arteries from the brain traverse and go to the face and the arteries come in from the neck. And so it's a very complicated area anatomically.

So when we have tumors or aneurysms that occur at the base of the skull, we have to drill the bone to get access to them, and this is a very complicated process. There is a steep learning curve that's involved with drilling the bone and preparing the approaches.

And one of the approaches that we do takes a long time. It's an approach to an acoustic tumor, a hearing nerve tumor, and it takes a couple of hours and in inexperienced hands, it may take longer than that. And so we felt that we could use existing CAD/CAM technology and transfer this to skull-based drilling.

Interviewer: Like they use in technology? You'll see these in a lot of manufacturing plants, this type of technology.

Skull Drilling

Dr. Couldwell: And if turn on your TV to the auto repair channels and that sort of thing, you'll see the machining out of a block of metal, a complicated piece based on a computer designed image of which the piece will look like. And so that's the same idea.

We take the particular skull of the patient and that individual skull and represent it in three-dimensional space with a computer program and then plot out the area to be drilled so that we end up with that opening that avoids the critical structures like the arteries and the nerves and the big veins. And so you can imagine that technology and you've probably seen it on some of these channels, in Discovery Channel and such, where it drills very quickly and it can make a very complicated part in a matter of minutes.

And it's actually easier to drill the bone. It's not that hard, and we basically have a Dremel type drill which drills the area of the bone out and then avoids the complicated structures, such as the arteries and the veins and the nerves, and we can actually set up a program with no-fly zones.

Interviewer: And there safety is built in too which fascinates me, like the facial nerve, if the facial nerve, as you said, becomes irritated, the computer will stop the drill completely which I think is amazing.

Dr. Couldwell: Right. It's a dead man's switch.

Interviewer: It sounds like you based it on kind of some existing technologies and software, the equipments out there, so you just order up a drill and put it in your garage and modified it?

Dr. Couldwell: No.

Engineering Design

Interviewer: How did it go from this idea then? Step me through that process. What was the next thing you did?

Dr. Couldwell: So Dr. McDonald and I, we engaged our engineering faculty here, the mechanical engineering faculty at the University of Utah, and we presented them with the idea that this may be an excellent application of existing CAD/CAM technology. All of it is standard technology. We really just brokered the use of this device and the technology for this application.

Now, the approach that we've used it for is basically a proof of principle, which means that we wanted to take a complicated cranial approach and demonstrate that it could add value by saving a lot of time and be very accurate.

But you can imagine this technology has lots of other uses. It could be used for simpler approaches. It could also be used to drill out specific bones elsewhere in the body. You can imagine a hip implant for instance where you could machine out the bone. There is the receptacle for the implant and make it a perfect match. So it has a lot of other implications.

Interviewer: When it came to developing, how long did it take from idea to the meeting with the department of engineering here at University of Utah to actually appearing in the operating room? Was that two years, three years, one year?

Dr. Couldwell: Oh, I think it was eight years.

Interviewer: It was eight years?

Dr. Couldwell: Yeah. It was conceived of eight years ago, and we obtained a grant to work from the University to work with the engineering department, two young graduate students within engineering got their degrees with this project. And so this is the kind of timeline that it takes, and then it took several years to wait for the patent.

Research Project Management

Interviewer: What about the project management aspect of this? You're a busy person so you don't really have time to manage the project. Was there some sort of an administration that had to be built around pushing this thing forward?

Dr. Couldwell: Yeah. I think that's a great question, and I think it represents the weakness in our academic systems insofar as that we have the technology and we have the expertise within engineering and the surgical fields to conceive of and invent these devices, but what we don't do as well is we don't have the ability to take it to commercialization and patent application as easily.

And people like me, I'm just a busy every day, practicing neurosurgeon. And so I don't really have the business expertise or acumen or the knowledge to be able to carry it forward. And so that's the gap.

Interviewer: Yeah. And what about like a project manager that as you're even developing it, just to kind of keep things moving forward and keeping everybody on the same page?

Dr. Couldwell: Yeah. And so the technology development office is very good for this, but still what we lack is the ability for the practicing physician to be able to conceive of and develop the company that should be developed to commercialize it.

Interviewer: Yeah, sure. So how many people were ultimately involved in this project over the course of the eight years?

Project Collaboration

Dr. Couldwell: Probably a dozen people between the engineering faculty, the administration, the technology development office and the surgeons.

Interviewer: And then over the course of that eight years, how much of your time did it take?

Dr. Couldwell: Relatively little when you consider the total amount of time. But it was ongoing. We had to prepare documents for the patent application, etc. and work with the attorneys and work with the development office with this. So probably maybe 5% of my time.

Interviewer: Got it. If somebody was to pursue a dream like this at their institution, what would be your first piece of advice for them?

Dr. Couldwell: I would say go for it.

Interviewer: That's good advice.

Dr. Couldwell: I think that they just need to be tempered in the enthusiasm in that the timeline is very long. The application process for obtaining a patent and the whole process took several years, and the commercialization piece is still going to take some more time. And so I just think that you need to have a long timeline. And so the best way to think of this is that you've got this project, but your life is going on and you're doing lots of other academic projects and your career goes on despite it. If it's successful, that's even better.

Interviewer: And what did you learn from the process that you would pass on to somebody?

Dr. Couldwell: I learned that even as an experienced and very busy neurosurgeon, I did not have the acumen to be able to take this forward and consider it as a business. And so you just need a lot of support around you, and I'm sure there's other people that could do it more efficiently than me but that's just not our space.

Interviewer: It sounds like involve as many people as possible with the specialties that you need.

Dr. Couldwell: Correct.

Interviewer: Got it.

Dr. Couldwell: And the university is actually becoming very . . . I think Utah is actually ahead of the curve on this. The university is very good at trying to take these ideas and making a practical decision about whether they move forward, and they were very helpful and I think they try to fill in those gaps.

Interviewer: Yeah. So you're still a ways out probably.

Dr. Couldwell: Yes. But we're having a lot of interest garnered in it right now, so I'm hoping to be able to push it forward.

Announcer: Be part of the conversation that transforms health care. Leave a comment and tell us what you're thinking. The Health Care Insider is a production of thescoperadio.com, University of Utah Health Sciences Radio.

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