Enabling immediate decision making in surgery

Much surgery is completed using electrosurgical devices that use an electrical current to rapidly heat tissue, cutting through it while minimising blood loss. In doing so, these devices vaporise the tissue, creating 'surgical smoke' that is normally sucked away by extraction systems.

This ‘smoke’ is actually a rich source of biological information, made up of a complex mixture of ionized molecules and neutrals caused by the rapid-evaporative ionization of tissue constituents including metabolites, lipids, peptides and proteins.

We are working with partners to exploit this source of biochemical information by coupling the sampling knife with a mass spectrometer (an analytical instrument used to identify what chemicals are present in a sample), which enables the real-time analysis of surgical aerosols.

The ultimate aim for iKnife technology is that the complex mass spectrometric data generated can be translated into clinically relevant information using machine learning methods for classifying the vast data obtained. This will enable immediate decision making regarding the continuation of the surgical intervention and real time diagnostic information, providing tissue profiling during surgery such as whether the tissue being cut is cancerous or not. This could greatly benefit the treatment of some cancers where tumour identification can be overly complex, or where it is difficult to ensure all traces of tumours have been successfully removed

Before any clinical uptake can begin, and the surgical benefits of the iKnife be felt, regulatory requirements that underpin patient safety must first be satisfied. Crucial to this is having a measured validation of acquired data and interpretation. To achieve this, we are undertaking a programme of fundamental mass spectrometry studies and rigourous validation using REIMS (rapid evaporative ionisation mass spectrometry) coupled to tandem mass spectrometry instruments. We will determine the effects of handling geometry, rate of ablation, sampling, volume of material consumed, optimum sampling rates and sensitivity to key tissue constituents. Over the course of a four-year project we will optimise routines to ensure repeatability of sampling, sensitivity and classification performance.