For surgeons who must remove a tumor during surgery, it is not always easy to be sure that all cancer cells have been removed. Moreover, during surgery, another factor is that it is not desirable - and even vital - to remove too much healthy tissue. To improve the removal of tumor tissue, scientists at the Maastricht MultiModal Molecular Institute (M4I) have developed the iKnife, a so-called ‘smart surgical knife’.
The clinical application of this smart surgical knife has already been studied extensively in recent years, in collaboration with UZ Leuven. That study showed that iKnife can recognize tissue from brain tumors, among others, as early as a few seconds, and with more than 98 percent precision, while cutting. For the further development of this technology, the European grant program Interreg Flanders-Netherlands made over 2 million euros available earlier this year.
Electrosurgical knife
iKnife is an electrosurgical knife that creates smoke during cutting when it encounters tissue during surgery. This smoke contains molecules and is a kind of fingerprint of the tissue. The information from that molecular fingerprint allows the surgeon to distinguish tumor tissue from surrounding, healthy, tissue. Something that is not visible to the naked eye.
Initially, the size of the device needed to analyze the information from the iKnife knife was an obstacle. Since then, the research team has been working with a more user-friendly, compact and handy screener. “Making our current iKnife, or molecular navigator, more compact is difficult because we want to minimize both sensitivity and accuracy. This means we face some tough technical challenges. For example, we have to use a different type of detector to make everything compact,” says M4I researcher Eva Cuypers.
This also means that the researchers must develop more compact solutions for the smoke supply. To help them with that development, AI is being used. “The final principle remains the same, though; this allows us to properly compare molecular profiles of the new system with those from our previously developed model,” Cuypers said.
Brain tumors
Smart operating knife technology is based on the mass spectrometry analysis technique. This technique substantially improves surgical decisions. An important development, because currently more than half (60%) of all brain tumor patients suffer a relapse within 5 years after surgery because leftover so-called residual cells grow back into a tumor.
With the iKnife, the researchers from MI4 and UZ Leuven expect that tumor cells can be recognized better and faster during brain surgery, and thus a tumor can be removed more completely, without affecting healthy tissue. “Once we have sufficiently proven that the technique offers advantages for this specific patient group, it is even conceivable that we will also use it to treat other patients, such as those with severe epilepsy,” says Maastricht neurosurgeon Olaf Schijns.
Cooperation with companies
To properly develop the molecular navigator, the scientists have gathered a nice team of researchers, surgeons and companies, thanks to the support of Interreg Flanders-Netherlands, Province of (Dutch) Limburg and Dutch State co-funding. For the further development of the compact navigator and the statistical analysis and user-friendly interface, collaboration with companies such as Next Generation Sensors and Aspect Analytics is crucial.
Neurosurgeons from Maastricht UMC+, Zuyderland in Sittard, UZ Leuven, Ziekenhuis Oost-Limburg (Genk) and AZ Groeninge (Kortrijk) will provide input and test the developed brain navigator as end users throughout the development process.
