Smart knife to modify surgery

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Conventional electrosurgery (Image: Imre Türös/University of Debrecen)

The  smell of burnt flesh rises in the operating theatre and the smoke from vaporised tissue is sucked away. But these fumes are diverted into a machine that tells the surgeon exactly what is being cut into, guiding the rest of the operation. This is “smart surgery“, and it holds the potential to transform medicine. This is the first NMR spectrometer in the world which does the work of a histologist.who identifies the tissue being cut/taken out.

The process tends to take about 40 minutes, and is subject to human error and variability. To standardise and speed up tissue identification, Jeremy Nicholson and his colleagues at Imperial College London have brought nuclear magnetic resonance spectroscopy – a chemistry-lab staple – into St Mary’s Hospital in London.NMR spectroscopy is most commonly used in chemistry to understand protein structures and chemical reactions. It utilises a property of the nuclei of different molecules that causes them to behave differently in a magnetic field: each absorbs radio waves at characteristic frequencies, enabling the machine to identify all the molecules in a sample.The technique could also cut down on costs, says Kinross. “The machine costs roughly around £200,000, but the cost of each analysis is very low,” he says, “and histologists are very expensive.”

The next step is to take the technique into surgical practice. Figuring out whether a lump is benign or a cancerous tumour, or where cancerous tissue stops or starts, can be a tricky business for a surgeon at the operating table. “An inflammatory mass can look and feel the same as a cancer,” says Kinross. “In those cases you perform the safest operation for the patient, and that might mean an extensive resection.”

If a surgeon needs to identify a particular tissue, the operation is put on hold for the 40 minutes it takes a histologist to analyse a sample. “The surgeons just stand around and tap their feet while the patient is left open on the operating table,” says Kinross.

The next step is to take the technique into surgical practice. Figuring out whether a lump is benign or a cancerous tumour, or where cancerous tissue stops or starts, can be a tricky business for a surgeon at the operating table. “An inflammatory mass can look and feel the same as a cancer,” says Kinross. “In those cases you perform the safest operation for the patient, and that might mean an extensive resection.”

If a surgeon needs to identify a particular tissue, the operation is put on hold for the 40 minutes it takes a histologist to analyse a sample. “The surgeons just stand around and tap their feet while the patient is left open on the operating table,” says Kinross.

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