Now we may be on the brink of a third revolution in surgery thanks to some
brilliant work by a young Hungarian researcher who has developed an
electronic “nose†attached to the electrosurgical knife. This sucks up the
smoke given off as the blade burns through tissue and analyses it in a
machine called a mass spectrometer.
The device can detect almost instantly what kind of tissue the surgeon is
cutting through – whether, for example, it is cancerous or not. This is
vital information. The key task in cancer surgery is to avoid leaving
cancerous tissue behind which may cause the disease to recur. Yet one in
five patients who have a breast tumour removed, and one in ten operated on
for lung cancer, has had to undergo re-operation after tissue samples
examined later in the laboratory showed traces of cancerous tissue still
remaining.
If the current re-operation rate could be reduced to near zero, as I believe
it can, it would spare thousands of patients from misery and save millions
of pounds for the NHS.
The “intelligent knifeâ€, or iknife, was invented by Zoltan Takats, who brought
his idea from Budapest to the Institute of Global Health Innovation at
Imperial College London set up by Lord (Ara) Darzi, surgeon and former
Labour health minister from 2007-9, to foster just such advances as this.
After two years of development we conducted tests in 91 patients which
showed the iknife could detect with 100 per cent accuracy whether the tissue
it was cutting was cancerous.
The technology was sold last month (July) to the US Waters Corporation, one of
the world’s largest suppliers of mass spectrometers which has the resources
to develop it, in a deal that is expected to see research grants worth tens
of millions of dollars returning to Imperial over the next few years to
transform the prototype into an approved medical device (the first was
agreed last week). The impact of this single innovation on cancer surgery
could be enormous.
But that is not all. The iknife has other potential applications which are
only just beginning to be explored. It can test food for the presence of
impurities and would have been a valuable asset in the recent horse meat
contamination scandal – it can detect as little as 1 per cent of the “wrongâ€
kind of meat. Nestle, the food manufacturer, is involved in a project to
develop the technology for quality checking ingredients. If proven, the
device has the potential to transform the monitoring of food security.
It can also be used to detect traces of illegal drugs – for example on a
person’s hands. But its biggest potential may be in the field of pathology.
Instead of removing a sample of tissue and examining it under the microscope
– a laborious and time consuming process – pathologists in the future may be
able to use a “wet electric brush†to sweep across the tissue to be tested,
analysing its surface chemistry and giving the surgeon instant feedback on
its nature.
That could change the way doctors diagnose disease for ever, consigning the
microscope with its boxes of slides from the centre of the laboratory to a
bench in the corner. It demonstrates why investing in new ideas is so
crucially important. What we learn with our noses from a piece of barbecued
meat may, with a touch of innovative genius, be developed into a technology
that transforms medicine, and much more.