This paper describes the design of a next-generation tool based on a smart mechatronic mechanism (SMM), specifically a smart mechatronic drill (SMD), whose operating algorithm is determined by the requirements for high-performance, defect-free drilling of live bone tissue. The relevance of such an automated and robotic technological operation in orthopedic surgery is due to several factors. First, during the initial penetration of the drill bit into the material, there is a risk of drill bit skidding due to the rounded shape of the tubular bone. Second, during stable drilling, it is critical not to exceed the threshold temperature of 47 ℃ in the cutting zone, as surpassing exceeding this limit leads to bone tissue necrosis. Finally, as the drill bit exits the drilled hole, it is essential to prevent chipping, cracking, and fraying at the hole’s exit, as well as drill bit breakage and breakthrough into soft tissue. To meet these technological requirements, the SMM has been developed as the basis for the SMD, a smart robotic drill, and a smart mechatronic spindle unit. A distinctive feature of the SMD is its automatic control (stabilization or tracking mode) of processing power parameters rather than kinematic ones. The control of power parameters is carried out based on the requirements for high-performance, defect-free drilling at the lower level of the hierarchical control system. At the upper level, the kinematic parameters of the drill bit’s movement are controlled to ensure high accuracy and processing efficiency.