When Seconds Count: Auto-Stopping, Cordless Hubly Drill Aims to Boost Safety & Decrease Costs

A craniotomy is the drilling of a hole into the skull, and it is the first step for most neurosurgical procedures. In many cases of traumatic brain injury, stroke, hemorrhage, ruptured aneurysm, hydrocephalus, or subdural hematoma, the treatment involves performing a craniotomy followed by a “ventriculostomy” or the insertion of an external ventricular drain into the brain. This procedure is often performed “bedside” outside of the operating room.

While craniotomies vary in size and complexity, variance in areas like precision, patient safety, and operating room (OR) efficiency are unwelcome. Now, a first-and-only device offers a much-needed technological update to this common, yet high-stakes procedure.

The FDA-cleared Hubly Drill—an auto-stopping, cordlessly powered, single-use drill—aims to make bedside cranial access safer, faster, and easier. Featuring advanced, new-to-market safety features, it promises to reduce the unnecessarily wide margin of error that even the most experienced neurosurgeons face when accessing the brain using a traditional, hand-cranked drill, which allows unintentional drilling beyond the skull and into the brain.

Hubly Surgical Brings SMART Auto-Stop to the Bedside

Reducing the risk of brain plunge is now possible outside of the OR thanks to the Hubly Drill’s SMART Auto-Stop feature. While perforators used in the OR use a pressure and clutch mechanism to trigger their auto-stop, the Hubly Drill utilizes a proprietary dual electrical/hardware SMART Auto-Stop technology that is easily restarted.

The Hubly Drill SMART Auto-Stop had 100% success in a safety study from Jackson Memorial Hospital at the University of Miami, in which neurosurgeons performed 174 craniotomies in a cadaver lab. In contrast, cranial perforators used in the OR have historically failed to stop 1% of the time (or in 1400 of the 140,000 annual burr hole placement procedures performed in the OR).

Following its official launch in Q1 2024, the Hubly Drill with SMART Auto-Stop has been used successfully to save hundreds of patient lives in emergency neurosurgical procedures.

Perforations Complete in 30 Seconds or Less

Time is of the essence with ventriculostomy, in terms of both patient safety and efficiency. According to the University of Miami study, each of 174 Hubly perforations was completed within 30 seconds. That study—which compared the Hubly Drill with a well-established, non-portable perforator for the OR only—found that the Hubly Drill completed 100% of 174 perforations versus the established perforator, which failed to complete 5.5% of perforations.

Researchers also noted that restarting the Hubly Drill offered advantages over the established perforator. If stopped, re-drilling can be done immediately and safely with the Hubly Drill, and the SMART Auto-Stop will engage. Additionally, the Hubly Drill did not observably heat, as opposed to the established perforator, according to researchers.

User Control and Ease-of-Use a Winning Combination

In the hands of an experienced neurosurgeon, the hand-crank drill has a complication rate of 2%, and 66% of all surgeons have experienced plunging. However, burr hole placements are routinely undertaken by less experienced surgeons, including junior residents. The Hubly Drill offers advanced features that may both ease the guesswork required of newer surgeons and the strain on those more seasoned.

An LED force indicator turns on when the user applies correct force, and changes color when SMART Auto-Stop occurs at the point of puncture through the skull. The Hubly Drill’s tapered drill bit geometry prevents the possibility of user plunge after SMART Auto-Stop.

The design of the drill itself aims to add comfort and convenience for all surgeons. While hand-cranked drills require two hands for use, have no inherent guidance or stability, and require bracing against the body, the Hubly Drill’s cordless design allows for single-handed drilling, increasing stability, ease of use, and speed. Plus, unlike today’s hand-crank standard, the Hubly Drill comes pre-assembled, saving time when seconds count in high-pressure situations. 

Bedside Access Can Be Cost Effective and Safe

Many craniotomy procedures are relatively simple and can take place bedside under local anesthesia. Doing so is beneficial to the patient because taking the procedure to the OR can involve general anesthesia-related complications as well as a significant time delay to receiving the often life-procedure. The minutes spent transferring the patient can delay a life-saving procedure, leading to poor prognosis, especially if the delay is greater than 70 minutes.

Keeping these procedures at the bedside is also beneficial to the hospital. The mean cost of taking a patient to the OR for burr hole placement is $7,588, plus the unrealized gains of using the room for a higher-paying, OR-necessary procedure. The hospital receives a set fee for the procedure regardless of where it was performed.

Tragically, complications are twice as prevalent for procedures performed at the bedside than in the OR. Hand-crank drills have a complication rate of 2%, and the average cost of a post-craniotomy complication was $22,539 as of 2022. So for hospitals that perform 200 burr holes annually, the potential cost due to complications could be $90,156.

Reducing bedside complications would increase access at the bedside, thereby increasing patient safety and hospital cost-savings. The Hubly Drill is designed to reduce these bedside complications and increase patient safety and prognosis.

The safety features and cost effectiveness of the Hubly Drill may alleviate some of the financial pressure hospitals face, as the potential costs of hand-crank drilling can quickly eat into the set fee hospitals are paid for inpatient procedures. Since the Hubly Drill is a single-use device that does not require sterilization, time and costs are saved on the materials side as well.

No surgical procedure is without risk, but those requiring bedside cranial access are particularly fraught. When speed & precision are paramount, the first-and-only advanced safety features of the Hubly Drill can give surgeons a new tool designed to lower risk, improve outcomes, and reduce cost.