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Cobotic drilling assistant for orthopedic surgery using Gaussian process-based breakthrough detection.

Lucas Gimeno1, Nils Johnson2, Tobias Stauffer2

  • 1PDZ, ETH Zürich, Rämistrasse 101, 8092, Zürich, Zürich, Switzerland. gimenol@ethz.ch.

International Journal of Computer Assisted Radiology and Surgery
|May 8, 2026
PubMed
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Human-robot collaboration (HRC) in orthopedic drilling significantly reduces soft tissue penetration (STP). This system uses advanced sensors to detect breakthroughs, enhancing surgical safety and accuracy for better patient outcomes.

Area of Science:

  • Orthopedic Surgery
  • Robotics in Medicine
  • Biomedical Engineering

Background:

  • Cortical bone drilling in orthopedic surgery demands high precision to avoid complications like soft tissue penetration (STP).
  • Human-robot collaboration (HRC) integrates surgeon expertise with robotic accuracy and stability.
  • Existing methods may lack the necessary precision, leading to potential risks during procedures.

Purpose of the Study:

  • To introduce a cobot-assisted system for cortical bone drilling, specifically for femoral or clavicular fractures.
  • To enhance surgical accuracy and prevent STP through robotic guidance and real-time breakthrough detection.
  • To leverage HRC for improved safety and efficacy in orthopedic drilling procedures.

Main Methods:

  • A robotic arm was developed to passively guide the surgeon and actively stop drilling upon breakthrough detection.
Keywords:
Fracture treatmentHuman–robot collaborationOrthopedic surgeryRobotics

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  • An online, model-free detection algorithm utilizing Gaussian process (GP) regression adapted to varying drilling conditions.
  • A user study with 16 participants in the experimental group and 17 in the control group, measuring STP with a depth camera.

    • Main Results:

    • The experimental group demonstrated superior performance, reducing STP by 6.79 mm compared to the control group (p<0.001).
    • The system achieved a 2.54 mm reduction in STP for generic bone cases compared to experienced surgeons' reported STP (p<0.02).
    • The proposed GP regression method outperformed baseline algorithms like thresholding.

    Conclusions:

    • HRC combined with online breakthrough detection significantly increases safety in orthopedic drilling.
    • The developed system shows promise for future clinical implementation in orthopedic surgery.
    • This technology offers potential applications in surgical training and improving procedural outcomes.