(also known as the Onkoknife or intelligent scalpel)
The principle technology behind this tool is called Rapid Evaporative Ionisation Mass Spectrometry (REIMS).
This technology was invented by Dr Zoltan Takats of Imperial College London. He realised that the smoke generated during electrodissection would be a rich source of biological information. He connected the electrosurgical knife to a mass spectrometer, an analytical instrument used to identify what chemicals are present in a sample.
iKnife allows near–real-time characterization of human tissue in vivo by analysis of the aerosol (“smoke”) released during electrosurgical dissection.
To establish the proof of concept a study was conducted where a variety of tissue samples from 302 patients were analyzed in the laboratory, resulting in 1624 cancerous and 1309 noncancerous database entries. The technology was then tested in operating theater, where the device was coupled to existing electrosurgical equipment to collect data during a total of 81 resections.
Tissue identification via intraoperative REIMS matched the postoperative histological diagnosis in 100% (all 81) of the cases studied.
In addition to real-time diagnostic information, the spectra provided additional information on varied tumor biochemistry that may help us better understand various cancers.
Now this technology has been acquired by Waters Corporation and being developed for use in clinical, microbiology and food safety applications.
The technology has been tested on Breast Cancer where 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. The time taken including data acquisition and analysis was possible within a mean of 1.80 seconds!
This has opened the pathway for its use in Breast Conservation Surgery. This is because over a fifth of patients undergoing BCS require re-operation for inadequate margins.
We hope to see more validation studies including other types of cancers. So that it can be utilized for a variety of cancers while reducing the cost per surgery.
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