iKnife: An Intelligent Surgical Knife Will Tell Surgeon If Tissue Is Cancerous

iKnife Is An Intelligent Surgical Knife Will Tell Surgeon If Tissue Is Cancerous

When surgeons can't determine the edges of a tumor, it's a problem. Cut too much, and they risk hurting the patient. Cut too little, and they may leave stray cancer cells behind. In cancers involving solid tumours, removal of the cancer in surgery is generally the best hope for treatment. The surgeon normally takes out the tumour with a margin of healthy tissue. However, it is often impossible to tell by sight which tissue is cancerous. One in five breast cancer patients who have surgery require a second operation to fully remove the cancer. In cases of uncertainty, the removed tissue is sent to a lab for examination while the patient remains under general anaesthetic.

Now, Dr. Zoltan Takats of the Imperial College London has developed one very sharp knife – and we're not referring to its keen edge. The Intelligent Knife (iKnife) is equipped with a nose and a brain that can sniff out cancer as it cuts. Using a mass spectrometer to detect chemical profiles associated with tumors, it enables instant identification of cancerous tissue and helps surgeons to make sure that all of a tumor has been removed.

iKnife is equipped with a nose and a brain that can sniff out cancer as it cuts

The iKnife uses electrosurgery; a common technique developed in the 1920s designed to reduce bleeding in particularly bloody operations, such as liver resectioning. The knife is subjected to an electric current, which heats tissue so fast and at such a temperature that the knife cuts through and cauterizes the tissue to prevent bleeding. Not surprisingly, this produces a cloud of unpleasant smoke, which is sucked away.

The inventor of the iKnife, Dr Zoltan Takats of Imperial College London, realised that this smoke would be a rich source of biological information. To create the iKnife, he connected an electrosurgical knife to a mass spectrometer, an analytical instrument used to identify what chemicals are present in a sample. Different types of cell produce thousands of metabolites in different concentrations, so the profile of chemicals in a biological sample can reveal information about the state of that tissue.

A member of 'intelligent knife' development team uses the knife on a piece of animal muscle. When surgeons cut and vapourize tumours, it produces a sharp-smelling smoke that can be analyzed for cancerous signals

Once the prototype iKnife was constructed, the next step was to teach it what to look for. This involved using the device to burn tissue samples collected from 302 surgery patients and building up a library of profiles of thousands of cancerous and noncancerous tissues from various organs of the body. As the iKnife cuts through tissue, it matches what it “smells” against this library and alerts the surgeon as to what it finds in about three seconds. This is a considerable improvement over the half hour needed for conventional laboratory tests.

The technology was then transferred to the operating theatre to perform real-time analysis during surgery. In all 91 tests, the tissue type identified by the iKnife matched the post-operative diagnosis based on traditional methods. According to Imperial College, the next step will be clinical trials where the surgeons will be allowed to see the results in real time instead of after the operation, as was the case in the tests.

“These results provide compelling evidence that the iKnife can be applied in a wide range of cancer surgery procedures,” Dr Takats said. “It provides a result almost instantly, allowing surgeons to carry out procedures with a level of accuracy that hasn’t been possible before. We believe it has the potential to reduce tumour recurrence rates and enable more patients to survive.”

iKnife has the potential to reduce tumour recurrence rates and enable more patients to survive

Professor Jeremy Nicholson, Head of the Department of Surgery and Cancer at Imperial College London, who co-authored the study, said: “The iKnife is one manifestation of several advanced chemical profiling technologies developed in our labs that are contributing to surgical decision-making and real-time diagnostics. These methods are part of a new framework of patient journey optimisation that we are building at Imperial to help doctors diagnose disease, select the best treatments, and monitor individual patients’ progress as part our personalised healthcare plan.”

Lord Darzi, Professor of Surgery at Imperial College London, who also co-authored the study, said: “In cancer surgery, you want to take out as little healthy tissue as possible, but you have to ensure that you remove all of the cancer. There is a real need for technology that can help the surgeon determine which tissue to cut out and which to leave in. This study shows that the iKnife has the potential to do this, and the impact on cancer surgery could be enormous.”

Lord Howe, Health Minister, said: “We want to be among the best countries in the world at treating cancer and know that new technologies have the potential to save lives. The iKnife could reduce the need for people needing secondary operations for cancer and improve accuracy, and I’m delighted we could support the work of researchers at Imperial College London. This project shows once again how Government funding is putting the UK at the forefront of world-leading health research.”

Takats sees the iKnife as having broader applications beyond cancer surgery. Mass spectrometry is a rather general tool and Takat says that it could be used to identify tissues with inadequate blood supply, the presence of certain bacteria, and might even be of use to the local butcher in telling beef from horsemeat.

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Write by: RC - Saturday, July 20, 2013