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Future Solutions In Progress

Theme 4: Smart Surgery: Innovative technologies or interventions to reduce, replace or refine invasive surgical procedures


Theme 4 Projects:


Immediate point of care molecular diagnostics for lung inflammation/infection in critical care
A new minimally invasive surgery for the treatment of corneal endothelial disease
Principal Investigator:  Professor Andrew J Quantock
Organisation: Cardiff University
Start Date 1st September 2012
End Date: 31st August 2015

View Abstract

The cornea is the transparent tissue at the front of the eye which allows light to reach the retina. If the cornea becomes cloudy, vision is impaired, a bit like looking through a frosted glass window.

Often the only treatment is a cornea transplant in which a surgeon removes the damaged cornea and replaces it with a donor cornea or part of a donor cornea. Often this has a good outcome, but the number of donor corneas available for surgery is limited, and risks such as infection or rejection remain.

Professor Quantock’s team at Cardiff University together with collaborators at Kyoto Prefectural University of Medicine and Doshisha University in Japan plan to develop a new surgery for corneal cloudiness which is caused by diseased or damaged cells that line the inside of the cornea. Under local anaesthetic, they will very gently touch the front of the cornea for a few seconds with a new surgical device which very quickly freezes cells. In doing so the diseased endothelial cells at the back of the cornea are destroyed. The researchers will then apply eye drops which will encourage healthy endothelial cells to grow and repopulate the inside of the cornea. In this way the cornea can become healthy and clear again.

Real-time detection of the onset of secondary brain injury in the intensive care unit
SmartTarget: Image-guided Diagnosis and Treatment of Localised Prostate Cancer
Principal Investigator:  Professor Mark Emberton
Organisation: University College London
Start Date 01st October 2012
End Date: 30th September 2015

View Abstract

In current practice, early-stage prostate cancer is managed without knowing exactly where cancer is in the prostate gland. As part of diagnosis, biopsy needles take tissue samples from the same predetermined areas in the prostate, regardless of where the cancer is, whereas targeting cancer seen in medical images is the standard procedure in most other cancers. This means that some clinically important cancers that require treatment are missed completely, some clinically unimportant cancers, which would otherwise have no impact on the individual's life expectancy or quality of life, are detected, and many other cancers are classified incorrectly as unimportant. As a result, current treatments try to compensate by treating not only the cancer, but the entire prostate gland. However, this approach gives rise to side-effects, such as incontinence, sexual problems, and back-passage symptoms, due to "collateral damage" to delicate structures surrounding the prostate.

Research led by Professor Mark Emberton and Dr Dean Barratt at University College London (UCL) seeks to rectify this situation. Their HICF-funded project proposes to combine state-of-the-art diagnostic imaging with advanced image guidance technology so that doctors are provided with information on cancer location, shape, and size during surgical procedures. The aim is to transform prostate cancer care by enabling doctors to target clinically important cancers so that these are diagnosed more accurately. They can then choose to target treatment only to the area of cancer so that tissue damage is limited and the risk of treatment-related side-effects is reduced. This approach is already applied when treating almost all other cancer.

The project focuses on developing a novel device called “SmartTarget” which will ensure that information on the location of cancer from medical imaging is at the centre of the diagnosis and treatment of prostate cancer. In particular, the SmartTarget system will exploit magnetic resonance imaging (MRI), which can detect clinically important cancers very accurately, and translate information on cancer location, size and shape automatically into the surgical setting so that it can be used to direct and guide prostate biopsy and new minimally-invasive cancer treatments. The system will achieve this by presenting the doctor with a “picture” that combines information from MRI with information from ultrasound images that are widely used to guide the biopsy needle and treatment delivery. This will allow the doctor to identify and target the cancer on a computer screen in a similar way to a fighter pilot presented with a target on a head-up display.

Anticipated benefits of this technology include fewer biopsies and more accurate cancer diagnosis. We also expect that the ability to implement a more selective treatment strategy will result in less harm and cost significantly less than current strategies which treat the whole prostate gland.

The specific objectives of the project are to develop and test a prototype SmartTarget device on patients, to develop detailed plans to commercialise the device, and to introduce the technology within the NHS (and potentially other healthcare systems) within a 5 year period.

Immediate point of care molecular diagnostics for lung inflammation/infection in critical care
Smart laparoscopic liver resection : Integrated image guidance and tissue discrimination
Principal Investigator:  Professor Brian Davidson
Organisation: University College London
Start Date 01st November 2012
End Date: 31st October 2015

View Abstract

Liver cancers can be removed using key-hole surgery with less pain, tissue damage, and blood loss and faster recovery times than traditional open surgery. However few cancers are removed by this method because of the difficulty in identifying and dividing blood vessels within the liver using key-hole surgery techniques. In addition, the position of the tumour and major vessels in the liver alters during the surgery due to patient breathing and liver traction. A research group headed by Professor Brian Davidson and Professor David Hawkes at University College London proposes to use the CT scan taken prior to surgery to identify the precise location of the cancer to the surrounding vessels and bile ducts and hence build a computer model of the liver for each individual patient. They will use this to monitor the position of the cancer and the major structures to the liver during the course of the key-hole surgery. This will be combined with a new method of detecting what kind of tissue is directly in front of the cutting instrument. This system is likely to result in a significant increase in the proportion of patients who undergo liver resection using key-hole surgery. The system will be validated on pigs and then evaluated on at least 25 patients. The system developed will also be applicable to operations on the pancreas, kidney and gallbladder.

Immediate point of care molecular diagnostics for lung inflammation/infection in critical care
Novel multimodality imaging techniques for neurosurgical planning and stereotactic navigation in epilepsy surgery
Principal Investigator:  Professor John Duncan
Organisation: University College London
Start Date 01st August 2012
End Date: 31st July 2015

View Abstract

Successful neurosurgery for epilepsy depends on removing the parts of the brain that give rise to seizures, and avoiding damaging areas undertaking vital functions such as language, movement and vision. Current techniques to direct surgery are based on MRI scans to show brain structure, but do not show areas needed for vital tasks, and do not permit interactive simulations of placement of recording electrodes in the brain.

A research group headed by Professor John Duncan at University College London and Dr Sebastien Ourselin of UCL Centre for Medical Image Computing has implemented methods to identify critical areas of brain function, connections and blood vessels and display these in 3D. They plan to develop this system to enable the neurosurgeon to plan the best operative approach for inserting recording electrodes and for planning surgical resections. This information will be made available in the MRI scan guidance system in the operating room so that operations are more precise.

They will produce a new system that will result in epilepsy surgery being planned more effectively, resulting in a higher cure rate and fewer complications.

ITAP transforming the lives of amputees
Perfecting soft tissue attachment interface to an osseointegrated transdermal implant to deliver a predictable and robust patient outcome
Principal Investigator:  Dr. Paul Unwin
Organisation: Stanmore Implants
Start Date 15th May 2013
End Date: 14th November 2016

View Abstract

About 5000 new amputees each year are referred to limb fitting centres in the UK. Traditionally amputees attach their artificial limb using a socket that fits onto the limb stump. Often attachment is cumbersome, uncomfortable and restricts daily activities.

In addition, the stump does not effectively transmit load and control movement. This causes tissue problems, which means that patients must frequently visit clinic and sometimes the artificial limb is not used due to discomfort. These long-term problems are a burden on the NHS and reduce amputees' quality of life. The ITAP system being developed by Paul Unwin and colleagues at Stanmore Implants Worldwide Ltd uses an implant attached to the bone that projects through the skin, to which the artificial limb is easily attached. This arrangement transmits load through the skeleton, which is how loads are naturally transferred. The success of the ITAP implant is reliant on the integration of the skin around the implant to create a seal to prevent infection. The objective of this programme is an implant that provides patients with an effective solution for the attachment of artificial limbs.

ITAP transforming the lives of amputees
Micro-IGES – Microscopic Image Guided Endoluminal Surgery
Principal Investigator:  Professor Guang-Zhong Yang
Organisation: Imperial College London
Start Date 01st April 2013
End Date: 31st March 2016

View Abstract

The current surgical technique for removing cancer from the body is generally effective however it carries a significant risk to patients during surgery and long-term post-operative problems such as chronic pain, disfigurement and poor quality of life.

Early stage cancer within a lumen, such as the colon, and precancerous polyps, can be removed endoscopically, thus avoiding the need to make a large incision on the body and potentially the creation of an artificial opening from the colon through the abdominal wall (colostomy). However, with the current instrumentation design, even tumours close to the external orifices of the bowel are difficult to remove with absolute certainty of completion. A project team led by Professor Guang Zhong Yang and Professor Ara Darzi at Imperial college are developing a robotic surgical device to facilitate tumour removal without the need for invasive surgery. Micro-IGES provides a novel microscopic surgical platform with a greater degree of precision and accuracy through integrated sensing, probe-based microscopic imaging and robotically assisted intra-operative guidance. The platform will be evaluated in both in-vivo animal models and human clinical studies.