Relying on a common lab technique for the analysis and identification of molecules present in a sample of material, the iKnife could significantly improve tumor removal surgeries. Its inventor, Dr. Zoltan Takats explains how the tool takes advantage of traditional electrosurgery to let doctors identify, in real time, exactly which tissue is cancerous, promising better outcomes for patients and reducing healthcare costs.
Screenshot from a video of the iKnife at work, being tested on a piece of meat.
When surgeons go in to remove a tumor, they have to be able to identify where the cancerous area ends and where healthy tissue begins. To do so requires a histological analysis to be carried out in the lab, while the surgery is already underway. The patient waiting under anesthesia, a single tissue sample is run to the histology lab, where it will take 20 or 30 minutes to get the necessary information on what’s cancer and what’s not. Not only is it slow, but this method also comes with reliability issues, says Dr. Zoltan Takats of Imperial College London, speaking at the First Day of Tomorrow event in Paris last month. These shortcomings of intraoperative histology have been recognized for 30 or 40 years, the researcher says. “We really need a real-time way to identify tissue in situ.”
Dr. Takats leaned on his expertise with the technique of mass spectrometry to develop a solution. Mass spec examines molecules of a substance when they are in the gas phase. The technique can be used to analyze solids or liquids through ionization, breaking the molecules into charged fragments, or ions. If this could be used during surgery, the nature of the tissue could be determined in place, in real time, with greater precision. The ionization step is key for the surgical application, Takats explained, as traditional equipment would be difficult to fit into the surgical environment.
Enter the iKnife: an “intelligent scalpel” that lets standard electrosurgery team up with mass spectrometry. In electrosurgery, an electric current in the blade heats the tissue to be cut, more or less burning through it, which helps minimize blood loss. Along the way, the high heat also vaporizes the tissue and that is where Zoltan Takats saw potential: he recognized, here, the ionization step of mass spec that stood in the way of using the technique in surgery. The smoke drifting up from an electrosurgery knife contains all the information about the tissue in question that the surgeon needs to delineate the cancerous area, making sure to get it all, while sparing healthy tissue. The iKnife captures this vaporized material, conducting the tissue analysis then and there.
The iKnife was tested in a study on 459 patients, Dr. Takats reported, performing with 92-100% accuracy, depending on the type of cancer. Next, his group will conduct a feasibility study. Two elements that would drive change in the cancer surgery market are greater accuracy in tumor removal and eliminating the need for intraoperative histology. Dr. Takats believes the iKnife responds to both and could result in shorter operations, lower rates of repeat procedures, and fewer complications following surgery. The added value for health care providers could be between 2,000 and 5,000€ per intervention. If all goes well, he thinks this innovative surgical tool could enter the market in 2017 or 2018. Whether or not this particular device finds its way into the operating room, mass spec is being used more and more for medical applications: in clinical toxicology, microbe identification, diagnosis of metabolic disorders, or to identify potential new biomarkers, to name a few. Dr. Takats may be right when he imagines mass spectrometry generating a whole new family of techniques.