Smart Scalpel: Bridging Electronics & Medicine for Enhanced Surgery

Recently, researchers have demonstrated a new smart scalpel that they claim could aid in teaching the next generation of surgeons and rapidly improve the speed at which students learn. What challenges do traditional teaching methods have, what did the researchers develop, and could its use extend beyond the classroom? 

What challenges do traditional teaching methods have?

Of all professions that exist, becoming a doctor is arguably one of the most difficult. Not only do those training to become doctors need years of university-level education, but they also require years of practice in the real world, shadowing other doctors, taking daily notes, reading up on changes in the industry, and taking responsibility for prescriptions and potential mistakes. 

However, becoming a surgeon not only requires a great deal of intelligence but also requires an exceptional level of dexterity. While anyone with a basic level of hand-eye coordination can stitch up incisions and cuts, it takes real skill to reattach severed nerves, cut around capillaries, and remove tissue in the most sensitive areas of the brain. 

Innovative Sensor Technology in Smart Scalpels and Advanced Training

The smart scalpel, developed by researchers at the School of Informatics, University of Edinburgh, represents a significant leap in surgical training technology. It is equipped with a novel force-sensing system embedded within its handle, transforming it into a sensor-loaded device. This advancement is crucial as, until now, there have been limited tools capable of measuring the force applied during surgery in real-life scenarios. Such measurements are vital for assessing surgical skills, which have traditionally relied on visual evaluations by experienced practitioners.

The incorporation of these sensors allows for the precise tracking of the scalpel's orientation, the pressure exerted during incisions, and the control exerted over time. This data is then analysed through a machine learning model, offering a more nuanced understanding of surgical dexterity than ever before. The smart scalpel's ability to capture and analyse such detailed data marks a significant step forward in both surgical training and the potential development of automated surgical technologies.

Challenges in Traditional Surgical Training

But even the greatest surgeons of all time required training to help refine their craft, and this requires hundreds of hours of practice. Currently, this kind of practice is given to students with the use of cadavers and fake flesh made from substances such as gelatine.

Attending educators (often experienced surgeons) can examine the work done by students and estimate their level of skill, but this type of examination is visual only, with little to no data on how the student held equipment, how much pressure was applied, and if damage would have been done to surrounding tissue. As such, training new surgeons is not only tedious but difficult to judge.

Recognising the challenges faced with modern training techniques for surgeons, researchers from the University of Edinburgh recently demonstrated their smart scalpel, which they say could help train surgeons of the future. To get a better understanding of how student surgeons perform, the researchers created a scalpel that incorporates numerous electronics, including an advanced processor and a multitude of sensors. As students use the scalpel in a teaching environment, the onboard electronics are able to determine the orientation of the scalpel as well as the pressure exerted on the scalpel and vibrations.

By collecting this data, the researchers can show exactly how much control the student had over the scalpel. For example, applying too much pressure indicates that the student needs more control, while subtle vibrations can indicate that the student lacks dexterity.

Enhanced Skill Assessment and Future Applications

The smart scalpel's technology goes beyond just tracking movements; it opens new avenues for assessing surgical skills. By comparing the data analysis of each participant's skills with assessments made by surgical experts, the researchers found a strong correlation between the two. This suggests that the smart scalpel could streamline the skill assessment process, making it more objective and data-driven.

Moreover, the insights gained from this technology could extend to various fields, including forensics and pathology, where precise tissue manipulation is crucial. The generative force model used in the smart scalpel not only quantifies surgical skill but also provides a deeper understanding of performance, potentially influencing how surgical training and operations are conducted in the future.

"We are excited to develop this new system, which uses a combination of real-life sensing technology and machine learning methods to quantitatively assess surgical skill. This system will enable the development of new systems for skill assessment and training, and could one day lead to the creation of automated surgical devices that can assist surgical teams." - Professor Ram Ramamoorthy, School of Informatics 

To demonstrate the capabilities of the new scalpel, the researchers teamed up with 12 medical students along with two surgeons to perform a procedure known as an elliptical incision. This type of cut is used to remove potential melanomas (found in the skin) and shows how well students are able to make complex curved cuts. However, the test itself was done on synthetic skin, as opposed to real-life cases where such an incision is needed. 

The results from the experiment showed that the data gathered by the device closely resembled what the attending surgeons examined. However, as the surgeons present contained a mix of neuroscientists and plastic surgeons, discrepancies in the quality of the incision arose due to different practices being deployed.

Could its use extend beyond the classroom?

While the technology could certainly help advance trainee surgeons, there is also another potential application for such a scalpel: medical monitoring. During surgeries, there can be times when a surgeon isn’t sure of how deep something may have been cut, whether additional incisions need to be made, or worse if they were responsible for some damage.

Thus, a smart scalpel could be used to not only provide insight into a completed procedure but also help surgeons improve their skills more rapidly. Furthermore, such a scalpel could also provide a level of protection for both patients and surgeons by providing a degree of transparency to patients. If, for example, a surgeon was responsible for causing damage, data gathered by the scalpel could prove this, and damage not done by a surgeon would absolve them of responsibility. 

Implications for Robotic Surgery and Automated Devices

The advancements in smart scalpel technology are not just confined to training human surgeons. The precise data collection and analysis capabilities of these instruments pave the way for their integration into robotic surgical platforms. By understanding the nuances of force application and control in surgical procedures, these sensorised scalpels could aid in the development of automated surgical devices. Such devices, equipped with the ability to perform complex procedures safely and efficiently, could revolutionise the field of surgery, augmenting the capabilities of surgical teams and enhancing patient care.

The scalpel demonstrated is bulky and large, but as with all developing technologies, this is just a prototype. It is more than possible for this design to be reduced not only in size but also in weight, making it possible to integrate into the handle of a regular scalpel. Will we see such tools on the market any time soon? No, but that isn’t to say that it won’t play an important role in the future.