By combining laser and imaging technology with AI, a research team in Jena, Germany, has been able to develop an innovative endoscope. This AI-guided endoscope allows surgeons to remove tumor tissue even more precisely, and in real time, during tumor surgery.
During surgical removal of a tumor in the rectum, it is extremely important that all tumor tissue is removed, with as little damage as possible - preferably none - to the healthy tissue surrounding the tumor. While a scan allows the surgeon to see exactly where the tumor is located, it is only after surgery that a new scan reveals how successful the procedure was. Although there are already technological solutions that can support surgeons during surgery, such as a 3D navigation system developed in the Netherlands, the German innovation is, as far as we know, the, or one of the first solutions where the result of surgery can be seen in real time.
Combining light with AI
A team at the Leibniz Institute of Photonic Technology (Leibniz IPHT) in Jena, in collaboration with Friedrich Schiller University (FSU), the University Hospital Jena and Grintech, which is based in the same stat, has developed an innovative solution to this problem: an endoscope powered by light and artificial intelligence accurately detects the borders of tumors, without using dyes.
“Our technology combines several optical imaging methods as part of a multimodal imaging approach to analyze the chemical and structural properties of tissue in real time. This allows us to identify tumor boundaries with high precision,” says Prof. Dr. Jürgen Popp. The scientific director of the Leibniz IPHT and director of the Institute for Physical Chemistry at the University of Jena, he and his team have been working on the technology for more than a decade. The system allows surgeons to receive real-time information about the tumor tissue. This allows them to decide during surgery which tissue still needs to be removed, but more importantly, which tissue does not need to be removed.
Integration of diagnosis and treatment
Unique to this new technology is the integration of diagnosis and treatment in a single device. A built-in femtosecond laser accurately removes diseased tissue while sparing the surrounding healthy tissue. “The 'see and treat' principle is an important advance because it makes surgery safer and improves patients' chances of recovery,” said Prof. Dr. Orlando Guntinas-Lichius, director of the Department of Otolaryngology at the University Hospital in Jena, Germany, and co-author of the study.
For surgeons, this means that tumors can be removed more precisely and effectively while preserving healthy tissue. This also greatly reduces the risk of follow-up surgery. This is not only a great advantage for the workload of these surgeons, but especially for the patient who does not have to undergo another major operation.
The innovative endoscope, with the procedure integrating treatment and diagnostics, has already been successfully tested in preclinical studies on tissue samples from 15 patients. The technology showed an accuracy of 96 percent in identifying tumor tissue and achieved an unprecedented level of precision in removing it.
A few weeks ago, an extraordinary innovation for, in this case, high-precision radiotherapy of tumors in the rectum was also introduced in the Netherlands. With the Maastro Rectal Applicator, tumors in that part of the body can soon be irradiated with much greater precision - directly 'on the tumor - and higher intensity.
Development and clinical application
A major contribution to the development of the technology for the new endoscope was made by Grintech, a company based in Jena, Germany, which developed high-precision miniaturized optical components for the endomicroscope and combined them into a complete applicator system. This allows detailed visualization of tissue structures and their chemical composition with the same quality as large laboratory microscopes.
The development of this technology is part of the TheraOptik project. The technology is currently undergoing preclinical testing. The next step is a clinical trial with a larger group of patients. “Our goal is to make this light-based method a standard tool in cancer surgery within a few years,” says Prof. Popp. In the long term, the technology could also be applied to other medical fields such as dermatology or neurosurgery.
