13. A Navigated Intelligent Knife for Breast Cancer Surgery
When a woman is diagnosed with breast cancer, several treatment options are considered including breast conserving surgery. In this type of surgery, the goal is to completely remove the cancer while leaving as much healthy breast tissue as possible. This is a clinical judgement of high consequence since resecting less tissue is cosmetically appealing but increases the chances of leaving cancer cells behind, known as a positive margin. Conventionally, this operation is performed with an electrocautery – imagine it as an electronic knife – which seals tissue as it cuts and produces small amounts of surgical smoke in the process. In most operating rooms today this smoke is treated as a by product, and it is discarded with no further consideration. But this smoke is rich with useful information; it contains traces of the molecules the knife passed through when the smoke was generated. The intelligent knife (iKnife) analyzes this smoke to determine the pathology of tissue the surgeon’s knife has passed through – whether the tissue is cancerous or not. We have coupled the iKnife with an electromagnetic position tracking system to create a three dimensional spatially resolved malignancy map showing where the surgeon’s knife has encountered cancerous tissue. We have developed a functional prototype and have approval for a first clinical safety and feasibility trial. We hope the spatial map will help surgeons to successfully remove the entire malignancy with the smallest amount of healthy tissue while maintaining negative margins – a successful surgical outcome for the patient.