Perhaps at no other time is it more critical to be able to distinguish healthy tissue from cancer than when a patient is on the operating table. As malignancies are not always discrete, it can be tough for the surgeon to tell where and how much to cut.
It’s typically rare to find a mass spectrometer in the OR, but if the results of a study published in Science Translational Medicine today hold up in other hospitals, it’s not hard to imagine the trusty machine could become commonplace there.
Dr. Nicholson and his colleagues at Imperial have created what they call an “intelligent” surgical knife, or iKnife, which couples rapid evaporative ionization mass spectrometry (REIMS) to electrosurgical dissection, and enables tissue identification in real time. The iKnife works by analyzing the surgical smoke produced by cauterization via REIMS, generating disease state-specific metabolic profiles.
Writing in Science Translational Medicine, the researchers report having applied this approach to analyze in the lab a variety of tissue samples from 302 patients. They also used the mass spec-coupled iKnife to analyze 81 surgical resections in theater—that is, performed in the OR. The researchers compared their metabolomic findings against the results of traditional, post-operative histopathological analyses, confirming the accuracy of their technique. Of the 81 resections performed, 100% of the intraoperative REIMS results matched the classic histology-based readouts. “These data provide compelling evidence that the REIMS-iKnife approach can be translated into routine clinical use in a wide range of oncosurgical procedures,” the researchers conclude.
According to Dr. Nicholson, the technique has been successfully applied to more than just cancers.
“We connect the exhaust pipe from the knife to a mass spectrometer and we can do tissue diagnostics in less than half a second, displaying the data that comes out of the iKnife mass spectrometer to the surgeon in real time,” Dr. Nicholson tells GEN. “It can give you information about tumor margin, to cut or not to cut, tissue viability, ulcerative colitis versus Crohn’s disease, cancer margins, different sorts of lymph nodes—it gives you an enormous range of background biochemical information in a surgical decision timeframe.”
The researchers have even used the iKnife to distinguish horsemeat from beef.
“It’s an absolute total revolution,” he adds, “not only in terms of the technology, but also the information delivered based on metabolism.”
Dr. Nicholson says future plans include to development and optimization of an intelligent endoscope, which could help physicians make treatment decisions related to lung biochemistry, for example. “Some of the technology we have developed for surgery actually can be redeployed in a different way for looking at other sorts of analytical problems, in fact any sort of complex mixture analysis in this way,” he notes.