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National Institute for Health Research

An 'intelligent knife' that tells the surgeon where to cut

When a surgeon is removing a tumour, it is not always possible to tell by sight which areas of tissue are cancerous and which parts are healthy. As a consequence, sometimes excess tissue is taken out, or the cancer is not completely excised.


This project is one part of our translational research programme to create new real-time diagnostics to improve surgical decision-making

Scientists at the Imperial NIHR Biomedical Research Centre (BRC) are developing a new surgical tool which could give instant feedback to surgeons about the tissue that they are cutting into, transforming the way in which they make decisions in the operating theatre.

SurgeryIn modern surgery, the simple blade has been largely supplanted by electrocautery, a technique that uses an electric current to rapidly heat soft tissue so that surgeons can cut through it with minimal loss of blood. This procedure gives off smoke which carries the molecular signature of the tissue that is being burnt. An Imperial team led by the surgical innovator Professor Ara Darzi (on the left in the photograph above) and Professor Jeremy Nicholson (on the right in the photograph above), who has pioneered the science of metabonomics, think that this signature could rapidly give valuable information to the surgeon as he or she is performing an operation.

Electrocautery can give off potentially harmful substances, so the smoke is usually sucked up and directed into an evacuation system. Now, the Imperial team have developed a modified electrocautery knife that instead sends the smoke into a mass spectrometer, which gives a rapid readout of the chemical composition of the smoke. Their preliminary research has found strong evidence that different tissue types and disease states give off a different molecular signature in the smoke.

We’re looking to completely transform the way that surgeons make sure they’re cutting in exactly the right place

A project grant from the Imperial NIHR BRC is now enabling them to test whether this setup can give surgeons rapid diagnostic information that can improve how they make decisions in the operating theatre. They hope to translate the mass spectrometer analysis into a simple readout that tells the surgeon what sort of tissue they are cutting in real-time.

Professor Ara Darzi“We’re looking to completely transform the way that surgeons make sure they’re cutting in exactly the right place,” Professor Darzi (left) says. “This will make surgery safer and improve our success rates at removing cancers. Ultimately, we hope to apply this approach to less invasive types of surgery, such as endoscopy and keyhole surgery. We think metabolic tissue profiling could really improve the way in which we carry out all sorts of operations.”

NMR machineThe project is part of a wider initiative between Imperial College Healthcare NHS Trust and Imperial College London that has created a Surgical Metabonomics Centre. This clinical phenotyping centre will bring biomolecular diagnostic techniques to the operating theatre for the benefit of surgeons and patients. BRC support has also enabled the team to install a nuclear magnetic resonance (NMR) spectrometer at St Mary’s Hospital - the first to be brought into a clinical setting. They anticipate that comprehensive analysis of tissue samples using NMR will be able to provide surgeons with an unprecedented level of information about the patient’s biological status, allowing them to optimise the patient’s treatment in ways that have not been possible before.

Professor Jeremy NicholsonProfessor Nicholson (left) said: “The intelligent knife project is one part of our major translational research programme to create new real-time diagnostics to improve surgical decision-making. It represents a major step forward in the application of systems medicine approaches for monitoring and improving the surgical patient journey through the hospital environment.”