A new generation of laser systems could soon help surgeons open skulls or vertebral canals with greater precision, adhere to exact cutting depths, and even analyse bone tissue during the operation itself. By emitting laser pulses that remove bone structures to within a few hundredths of a millimetre, researchers are developing robot-assisted systems that can monitor and adjust these cuts in real time. This approach may benefit patients undergoing brain tumour removal or spinal surgery by reducing vibrations, noise, and the overall physical and psychological impact of traditional procedures.
Precision Laser Surgery for the Skull and Spine
Today, surgeons often use high-speed drills or bone cutters to remove sections of the skull or vertebrae. These tools generate noise, vibration, and heat, potentially stressing both the patient and the surrounding tissues. By contrast, a short-pulse laser can ablate bone in microscopic increments without direct contact or excessive force. When the laser’s infrared pulses strike the bone, they instantly vaporise water within the tissue, causing tiny fragments of bone to break away—quietly, without heavy vibrations.
A laser applicator can distribute these pulses precisely across the bone surface. Some systems also overlay a measurement beam, such as Optical Coherence Tomography (OCT), which scans the cutting depth and remaining bone thickness. Real-time data analysis then stops the laser the moment the bone reaches a predefined thickness, leaving a thin lamella that is easily removed or hinged open.
Surgeons could, in principle, perform significant skull openings under local anaesthesia in a patient who remains awake. This can be especially valuable when removing larger tumours near critical regions of the brain. Because the patient can respond to questions or commands during surgery, the medical team can detect early signs of functional impairment and avoid removing essential brain tissue. After the procedure, the bone flap—cleanly cut by laser—could be replaced more easily, with minimal thermal or mechanical damage at the edges.
Potential Benefits for Spinal Operations
Laser-based systems may also reduce risks during spinal surgery. Conditions such as spinal canal stenosis involve bony overgrowth pressing on the spinal cord, causing chronic pain and even paralysis. Surgeons usually rely on cutting tools applied forcefully to open the vertebral canal, working perilously close to sensitive nerves. A slip or miscalculation can lead to severe complications, including incontinence or paralysis.
By contrast, a robot-assisted laser system can make precise cuts without contact, using OCT or other optical scans to stop at a safe bone thickness. The need for physical force is eliminated, which reduces the chance of accidental damage to the spinal cord or nerve roots.
Because traditional drills provide some tactile feedback as they bite into bone, developers are integrating new forms of “artificial” feedback. In a robotic setup, the laser applicator may be attached to a collaborative robot arm (cobot). The cobot can provide resistance or “haptic” sensations whenever the tool reaches a critical boundary. This ensures that surgeons remain aware of the cutting progress, effectively preventing them from straying into vulnerable areas such as nerves or delicate tissues.
Real-Time Bone Analysis
Another emerging possibility involves combining laser surgery with rapid bone analysis. During operations on the jawbone, for instance, doctors must ensure that they remove all cancerous bone material while preserving as much healthy tissue as possible. Sending bone samples to a lab takes time and can lead to extensive removal of unaffected bone.
Laser-Induced Breakdown Spectroscopy (LIBS) offers a potential solution. By firing tiny laser pulses at the bone, a small amount of tissue vaporises and forms a plasma that emits light as it cools. A spectrometer connected to the applicator can read this light signature to determine the bone’s elemental composition. Healthy and cancerous bone have distinguishable spectra, allowing surgeons to check the margins intraoperatively. This could mean more accurate removal of only the cancer-infiltrated bone plus a small safety buffer, potentially preserving more healthy structure for reconstruction or future implants.
Towards Simpler Fibre-Based Systems
Many of today’s research prototypes use mid-infrared lasers that cannot be channelled through conventional glass fibres. Instead, they rely on articulated mirror arms, which are bulky and require careful alignment. However, researchers are now working on short-pulse solid-state lasers that operate at a wavelength of around 3 micrometres, making it feasible to deliver the beam through a fibre. This shift could lead to smaller, more flexible, and less complex surgical devices—better suited to the cramped spaces of an operating theatre.
Challenges remain, including the need for high-energy pulses in short durations and at rapid repetition rates. Yet if these lasers can be successfully developed, they will offer a substantial upgrade in portability and ease of use compared to large CO₂-based machines.
Future Outlook
Although fully autonomous robotic surgeries remain a distant goal—given the complexity of operations, the risk of bleeding, and patient-specific anatomical variations—these new laser systems are moving towards a more automated workflow. Real-time optical monitoring can stop the laser once a safe threshold is reached, robotic arms can provide steady guidance and tactile feedback, and integrated spectrometers can confirm whether cancerous cells are present.
For patients, this could translate into safer and less invasive procedures. Whether it is relieving pressure on the spinal cord or precisely removing a brain tumour, laser surgery has the potential to minimise damage to healthy tissue. It may also enable important neurological checks during operations, when preserving function is critical. Eventually, the hope is that these laser-based methods will deliver more precise, quiet, and patient-friendly surgeries—with shorter recovery times and better outcomes overall.