Cutting Edge: The Smart Knife

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September 30, 2011 by Dan Swinhoe

Surgery is never an exact science.

 After every operation there are tentative discussions about how well it went, and in the weeks following constant worry about the return of the problem.

New research could change all that. Currently in development is a knife, one that will be able to tell the surgeon what is being cut into, that could mean that surgeons are less likely to make mistakes and more able to identity if tumours are fully removed.

The knife has the potential to be used on a variety of surgeries, “Gut, cancer, anything in principle,” explains Professor Jeremy Nicholson, Head of The Department of Surgery and Cancer at Imperial College London and Cancer Clinical Programme Group/Stratified Medicine Research Leader. “A computer program analyses the data and provides diagnostic readouts for the surgeon – this is still in development of course.”

In most surgeries the scalpel has been replaced by electrocautery, where an electric current cuts through the tissue and reduces blood loss. This method produces smoke that is normally evacuated through a ventilation system. But scientists at the Imperial Comprehensive Biomedical Research Centre (cBRC) have developed a method where the smoke is sent into a mass spectrometer. The smoke is then analysed and it’s chemical composition readout, and the theory is each type of tissue gives a different readout, therefore allowing the surgeon to see what is being cut into.

The ‘smart knife’ is still in development but early signs are that there is strong evidence that this will work. As well as cancer surgery, there is hope that it can be used on other procedures, such as endoscopy and keyhole surgery.

Mass spectrometers are quite large but Jeremy points out operating theatres are already full of large equipment, and one more that could make such a difference is a fair trade-off.  “It doesn’t replace anything, it uses existing equipment in a new way to provide diagnostic information, thus enabling improved decision making – to cut or not to cut.”

While the equipment that makes up this new smart knife already exists, it’s not just a case of stitching them together. “The MS systems already work well as do the knives, the technological difficulty lies in coupling them together and building the diagnostic models. But we have the knowledge and funding to put this together.

“We will have a prototype in one of our theatres next year to generate the information need to build the models, but it will take a couple of years to develop the data visualisation tools.” While Jeremy isn’t exact with the figures he estimates that a working prototype will cost around £3 million. The cost to buy one of these machine is out of his control. “We are working with the big MS manufacturer, Waters, to build the machines.”

But despite not being able to name the price, the machines won’t restrict the knife to private hospitals. “The deployment of these technologies will save money as well as lives,” he explains, “it should reduce the number of surgical complications and improve patient safety.”

And the safety of patients is the main concern, and the new knife is just one of many projects in the pipeline to help improve surgery. “The faculty of medicine has just been awarded a National Institute for Health Research grant of £113 million to fund our biomedical research centre”.

He explains that over the next five years the grant will be used to “develop improved translational treatments, of which £7 million goes into stratified medicine which powered the patient phenotyping and realtime diagnostics programme.”


(Photo: Tom Scott via Flickr creative commons)

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