Distinguishing Cancerous From Healthy Tissue During Surgery With the Smart Scalpel iKnife

Some tumors have a clear boundary with healthy tissue, while for others it can be difficult to distinguish healthy from cancerous tissue. Surgeons therefore need to know what they are cutting out of the body. One example is ovarian cancer. It can be difficult to determine whether an ovarian mass-like formation is benign or cancerous, which can complicate surgery.

Currently, women with suspicious ovarian or pelvic (groin-region) masses often undergo extensive surgery removing both ovaries, both fallopian tubes, the uterus and cervix together. This operation is abbreviated TAH-BSO (Total Abdominal Hysterectomy - Bilateral Salpingo-Oophorectomy). Pathology reports completed later sometimes reveal that this extensive operation removed more tissue or organs than necessary. Removing too little tissue, however, can lead to further surgery.

What is needed is a tool enabling surgeons, during surgery, to distinguish healthy from cancerous tissue. An experimental device called "iKnife" (smart scalpel) may make this possible.

What Is iKnife?

iKnife is a different kind of surgical tool. It not only cuts during surgery but can be programmed to identify the tissue being cut as it cuts.

iKnife was invented at Imperial College London by Professor Zoltan Takats and his team. When designing it, they connected a standard surgical knife to a highly sensitive molecular weight scale.

Many surgical knives today also have laser capabilities, meaning they cauterize/burn tissue while cutting, reducing bleeding. iKnife both cuts and burns tissue, making it a laser scalpel. It also analyzes molecules in the tissue with a device called a mass spectrometer for this analysis.

Cancer cells contain molecules different from normal cells, and mass spectrometers can reveal different molecules with great sensitivity.

Promising Initial Results

The research team began by testing samples collected during ovarian cancer surgery and comparing the results with pathology reports.

They showed that iKnife could diagnose ovarian cancer by distinguishing normal from cancerous tissue with % 93 to 100 accuracy. This is an extremely exciting result.

More limited surgery also means a greater chance of preserving fertility, particularly for young patients.

Next Steps

Cancers other than ovarian cancer are also expected to benefit from iKnife. Scientists are currently testing it in breast canceras well.

Another area where iKnife may be especially useful is thought to be brain tumors , and brain tumor surgeryhas also begun testing iKnife. The basic principle in cancer surgery is to remove the tumor with some surrounding healthy tissue, accounting also for invisible micro-metastasesin this approach. But in the brain, as little brain tissue as possible should be removed. iKnife may therefore improve brain surgery outcomes.

More testing is needed before we know whether iKnife can make cancer surgery much smarter, but the benefits could be enormous. If it can provide an accurate diagnosis during surgery, it could change surgical approaches and allow personalized operations for each individual.

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