“Intelligent Knife” Set to Revolutionize Cancer Surgery: SelectScience Interviews its Creator, Dr Zoltan Takats

Scientists have announced the development of an “intelligent knife” (iKnife) that is able to rapidly distinguish between healthy and cancerous tissue. Bringing mass spectrometry into the operation theatre to “sniff” out cancer is an exciting prospect for many scientists.

In a pilot study, published in the journal Science Translational Medicine, the iKnife correctly identified samples from 91 patients while they underwent cancer surgery. The iKnife has the potential to significantly improve current surgical procedures, reduce tumor recurrence rates and enable more patients to survive.

In order to find out more about the technology behind this pioneering tool SelectScience spoke with its inventor, Dr Zoltan Takats from the Department of Surgery and Cancer at Imperial College London.

Overcoming Current Challenges in Surgical Procedures

Accurate and reliable tissue analysis is fundamental to the success of many surgical procedures including those carried out on cancer patients. In cancers involving solid tumors, removal of the cancerous tissue using surgery generally provides the best clinical outcome. Dr Takats explains a major challenge surgeons face is trying to remove all the cancer cells while preserving as much of the surrounding healthy tissue as possible.

Currently if a surgeon is unsure whether the tissue is normal or cancerous they can, under certain circumstances, send the sample for analysis in the hospitals pathology lab, which takes approximately twenty to thirty minutes. This time is spent with the patient still open on the operating table and these laborious methods may compromise the surgeon decision making process. Dr Takats recognized the need for a tool that could analyze tissues in real-time.

An Inspired Solution

During his time in operation theatres Dr Takats noticed the routine use of electrosurgical knives, which were initially invented in the 1920’s. He explains how electrosurgical knives use an electrical current to rapidly heat tissue, thereby cutting through it while minimizing blood loss. In the process the tissue is vaporized to create a smoke of gaseous ions.

The breakthrough came when Dr Takas realized the smoke generated by electrosurgery could be analyzed using mass spectrometry. The mass spectrometer is able to create a chemical profile of the tissue almost immediately. Because different cell types produce different concentrations of metabolites their chemical profiles differ.

In a new study, researchers first used the iKnife to analyze tissue samples collected from 302 surgery patients, recording the characteristics of thousands of cancerous and non-cancerous tissues, including brain, lung, breast, stomach, colon and liver tumors to create a reference library. The iKnife works by matching its readings during surgery to the reference library to determine what type of tissue is being cut, giving a result in less than three seconds.

Mass Spectrometry as a Routine Analytical Method in Cancer Surgery

The evidence collected so far shows that the iKnife can predict the histological features of tissue with the same accuracy as other, more time consuming methods. A prototype is currently being developed for large scale clinical trials.

While Dr Takats appreciates there is still a long way to go before the iKnife receives regulatory approval he is extremely excited about the prospect of the device being translated to a routinely used clinical tool.

Several surgeons have already echoed Dr Takats excitement surrounding the iKnife. It is widely accepted that current methods are too time consuming and the iKnife could reduce the time spent in theatre for many patients. The iKnife technique provides a valid alternative to frozen section histology to enhance real-time intra-operative decision making.

Other Applications of the iKnife

While the applications of the iKnife in cancer surgery have recently made headlines, Dr Takats is also keen to discuss several other potential applications of his invention.

The iKnife could be used in any surgical procedure in which rapid tissue analysis is required for example in amputations, IBD operations and in A&E. The iKnife is capable of identifying tissues with inadequate blood supply and can also identify different bacteria within a tissue sample.

Dr Takats explains how many other surgical tools, such as lasers, cause tissues to produce gaseous ions suitable for analysis using mass spectrometry. Instruments similar to the iKnife could be fashioned to accommodate other surgical methods, thus this technique is not limited to electrosurgery.

The study was funded by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, the European Research Council and the Hungarian National Office for Research and Technology