On Wednesday, doctors reported that an experimental surgical knife termed an iKnife has been recently developed that can tell a doctor when all cancer is removed. The way the knife detects if all cancer’s been removed is to smoke it out.
The iKnife is able to distinguish between tumors and the healthy tissue that surrounds them. This device has been referred to as the “magic wand” and it could revolutionize cancer surgery.
How does the iKnife work?
Surgeons typically use knives that heat tissue as they cut. This produces a sharp-smelling smoke. The new knife is able to analyze the smoke as it cuts. It can instantly signal whether the tissue is cancerous or healthy.
The iKnife’s inventor, Dr. Zoltan Takats of Imperial College London, suspected the smoke produced during cancer surgery might contain some important cancer clues. So he designed a ‘‘smart’’ knife hooked up to a refrigerator-sized mass spectrometry device on wheels.
The smoke from the cauterizing tissue is analyzed, and then it’s compared to a library of smoke ‘‘signatures’’ from both cancerous and non-cancerous tissues. Color-coded information appears on a monitor: green means the tissue is healthy, red means cancerous and yellow means unidentifiable.
Now, surgeons must send samples to a laboratory while the patient remains on the operating table to make sure they’ve removed the tumor. Even in the best hospitals, it can take about 30 minutes to get an answer, but even then doctors cannot be entirely sure. They often remove a bit more tissue than they think is strictly necessary just to be on the safe side. Then, if some cancerous cells remain, patients may need to have another surgery or undergo chemotherapy or radiation treatment.
The new knife and its accompanying machines cost about £250,000 ($380,000) to make, but scientists said the price tag would likely drop if the technology is commercialized and the devices are mass-produced.
Currently, the most common treatment for cancers involving solid tumors is removing them in surgery. However, it can be difficult for surgeons to tell if they’re removed all of the cancerous material. One in five breast cancer patients who have surgery in the UK will need further operations to get rid of the tumor entirely.
Between 2010 and 2012, scientists tested the new knife at three hospitals . Tissue samples were taken from 302 patients. The samples were used to create a database of which kinds of smoke contained cancers, including those of the brain, breast, colon, liver, lung and stomach.
The database was then used to analyze tumors from 91 patients. The smart knife correctly spotted cancer in every case. On Wednesday, the study was published in the journal Science Translational Medicine. Groups including Imperial College London and the Hungarian government paid for the research.
The new knife resembles a fat white pen. Doctors used it at a demonstration in London on Wednesday, to slice into slabs of pig’s liver. The room was filled with an acrid-smelling smoke within minutes, comparable to the fumes that would be produced during surgery on a human patient.
According to Takats, the knife will eventually be submitted for regulatory approval but more studies were planned.
Other uses of the knife could be for other things like identifying tissues with bad blood supply and identifying the types of bacteria present.
The technology, experts believe, could help eliminate the guesswork for doctors operating on cancer patients.
According to Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society:
Brain cancers are notorious for infiltrating into healthy brain tissue beyond what’s visible to the surgeon. If this can definitively tell doctors whether they’ve removed all the cancerous tissue, it would be very valuable.”
Still, Lichtenfeld said more trials were needed to prove the new knife would actually make a significant difference to patients. Early enthusiasm for new technologies hasn’t always panned out, he said, citing the recent popularity of robotic surgery as an example.
Lichtenfeld said it’s unclear whether more widespread use of the smart knife will actually help patients live longer. He said studies should also look into whether the tool cuts down on patient’s surgery times, their blood loss and rate of wound infections.
“This is a fascinating science and we need to adopt any technology that works to save patients,’’ Lichtenfeld said. “But first we have to be sure that it works.”
This knife will mean that patients having to undergo fewer operations, be left with smaller wounds, and they will also have a greater chance of survival after their operations.
The new surgical iKnife that can tell when all cancer is removed is currently being used in three London hospitals.
Written by: Douglas Cobb