When surgeons remove tumor tissue they try to leave a "margin" of healthy tissue to
ensure all the cancer is removed. Sometimes this means the patient has to remain under
general anaesthetic for another 30 minutes or so while tissue samples are sent
for analysis to check if the margin is clear. Even then, it is still possible
that some cancerous tissue remains, and the patient has to undergo further
surgery to remove it.
Now, a new technique based on an "intelligent knife," called
the "iKnife," promises to remove the need for lab analysis and
the accompanying delay, and it also helps avoid repeat surgeries.
The iKnife sniffs the "smoke" created by the electrosurgical
removal of cancerous tissue and tells the surgeon almost immediately if the
tissue it has come from is healthy or cancerous.
This first study appears online this week in Science Translational
Medicine, in which the iKnife is tested in the operating room.
In tissue samples from 91 patients, researchers at Imperial College
London using the iKnife achieved 100% accuracy in diagnosing whether the
samples were cancerous or not.
Study author Dr. Zoltan Takats is the inventor of the iKnife. Asked if
his new surgical tool would be confined to use in only certain types of cancer,
he told Medical News Today:
"It
is a generally applicable tool, we believe it will be useful for many different
types of cancer surgeries."
On the question of cost-effectiveness, Dr. Takats told us:
"We
believe that it will be a cost-saver - due to elimination of intraoperative
histology, shorter intervention times and lower rate of re-operations."
iKnife combines electrosurgery with new mass
spectrometry techniques
The iKnife is a combination of an established technology called electrosurgery
that was invented in the 1920s and a new technology that is still emerging,
called rapid evaporative ionization mass spectrometry (REIMS).
In electrosurgery, the surgeon's knife delivers an electric current that
heats the target tissue and cuts through it while causing minimum loss of
blood.
The heat from the current vaporizes the tissue, which gives off a smoke
that is normally sucked away with an extractor.
The mass spectrometer technology behind REIMS almost instantly
identifies the chemicals present in human tissue by analyzing the smoke that is
released during electrosurgery.
Cells produce thousands of metabolites in various concentrations,
depeding on their cell type. So once the REIMS technology is primed with the
profiles of healthy and cancerous cells, it can rapidly use these to screen the
sample of smoke and inform the surgeon whether it is from a tumor or healthy
tissue.
Results delivered in under 3 seconds
By comparing the chemical profile of the tissue it is sampling to the
reference library, the iKnife can deliver a result in under 3 seconds, say the
researchers.
But for this study, the surgeons carrying out the procedures were not
allowed to see the nearly instant readings from the iKnife.
The researchers now hope to run a clinical trial that tests whether
giving surgeons access to iKnife readings during operations improves outcomes
for patients.
Dr. Takats says in a statement:
"These results provide compelling evidence that the iKnife can be
applied in a wide range of cancer surgery procedures."
As the technology delivers almost instant results, it allows
"surgeons to carry out procedures with a level of accuracy that hasn't
been possible before", he adds, noting that they "believe it has the
potential to reduce tumor recurrence rates and enable more patients to
survive."
Source: Medical News Today
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