In a study published yesterday in Science Translational Medicine, a group of medical researchers based in the UK announced the iKnife, a potentially radical innovation in electrosurgery. The product, which is essentially a smart electro-scalpel, may soon allow surgeons in hospitals around the world to identify cancerous or other diseased tissue as they are operating.During electrosurgery, electrical current is applied to cut or remove biological tissue. The process involves cauterizing wounds as they are made, resulting in aerosol or smoke as the flesh burns. The smoke is unsettling and not just because it smells awful. According to the CDC, research has confirmed that electrosurgical smoke may contain harmful materials, including hydrogen cyanide, formaldehyde, and viruses.However, even noxious plumes of burnt tissue have an upside: using a technique called Rapid Evaporative Ionization Mass Spectrometry (or REIMS), the iKnife is able to test the chemical signature of the electrosurgical smoke byproduct and determine whether or not the tissue being operated on is cancerous. It’s sort of like a sonic screwdriver for the OR.So far, this advancement has proven incredibly accurate. In the most recent study, the research team analyzed around 3000 tissue samples—1624 cancerous, 1309 non-cancerous—and entered the results in a database. The device was then taken into an actual operating room to test its in vivo analytical capabilities. In all examined cases, the iKnife was able to accurately distinguish cancerous from non-cancerous tissue according to the database.Although clinical trials still await and the product itself may not be available for two to three years, it’s clear that the iKnife has much promise. Surgeons will no longer have to pause surgery to send samples down to the pathology lab for testing while their patients remain anesthetized. Instead, they will know in mere seconds whether or not a tissue is diseased. It will also become easier to tell whether or not an entire cancerous mass has been removed, leading to less risk of relapse down the proverbial road.It could even have applications in the realm of robotic-assisted surgery, said Zoltán Takáts, one of the lead researchers on the project. It hasn’t yet been implemented, but at least the robots won’t mind the smoke.The researchers know how valuable this tool will be. Takáts pointed out several other applications in addition to cancer surgery: food analysis, veterinary applications, bacteria identification, industrial process control, and so on. He has already established a company, MediMass, and given it the trendy iKnife name to better sell the product when the time is right. The price tag is high, hovering around $380,000, but the team argues that the tool could end up saving hospitals money since they will be able to reduce surgical and pathology staff.
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