PreCisE: A Precision laser scalpel for Cancer diagnostics and Eradication

The world's population is rapidly growing and, most importantly, at the same time is ageing. This provides a driving force for the increase in cancer, which is predicted to grow from 18.5M in 2018 to 29.5M in 2040. One of the most effective strategies to combat cancer has been the introduction of screening programmes, which enable the disease to be detected at an earlier stage when it is curable. Earlier stage disease also lends itself to minimally invasive and endoluminal surgery, with advantages in terms of reduced morbidity and better preservation of normal function.

There is an acceptance that the use of minimally invasive and endoluminal surgery will continue to grow, perhaps in conjunction with robotic-assistance. But, to deliver this ambition, appropriate surgical tools need to be developed. This includes tools for real-time diagnosis of cancer that can be coupled with ablative and excisional modalities to eradicate the disease. Combined diagnostic and ablative tools will enable microscopic disease to be detected, particularly at cancer margins where infiltrative growth is difficult to distinguish from normal tissue. Failure to eradicate such microscopic disease is usually the cause for treatment failure and cancer recurrence.

Our multidisciplinary team of physical scientists, engineers, laser specialists, and clinicians have begun to address this shortfall in surgical hardware precision by investigating a new laser-based approach ideally suited for minimally invasive and endoluminal cancer surgery. By employing "ultrashort" picosecond lasers, that deliver energy in a series of pulses only a few picoseconds long, we have demonstrated the ability to remove (ablate) tumours on a precision 2 orders of magnitude smaller than existing tools. Importantly, because the laser pulses are so short, there is no time for heat to diffuse into surrounding tissue, as is the case for existing surgical tools. Therefore, we have shown that damage to tissue around the surgical zone can be restricted to less than the width of a human hair - almost on the scale of individual cells.

On clinically relevant tissue models we have demonstrated in the laboratory that this picosecond laser ablation could provide a step change in precision resection of the bowel and hence transform endoluminal colorectal cancer surgery. Additionally, we have shown that ps laser pulses can be flexibly delivered via novel hollow core optical fibres giving confidence that endoscopic deployment can be realised and opening up new areas of minimally invasive procedures.

We now need to capitalise on this foundation and have therefore expanded our network of clinical expertise and identified new areas where our technology could be truly transformative. Neurosurgery is the ultimate test of precision, even microscopic loss of healthy tissue can have a huge impact on quality of life. In head and neck surgery, minimising resection of normal tissue allows functional preservation of speech and swallowing, positively influencing quality of life outcomes. In parallel, we aim to build on our successful results in colorectal cancer by developing novel strategies for incorporating real-time diagnostic imaging aiming towards clinical application. The proposal will take our understanding of lasers in colorectal cancer surgery towards clinical application, whilst simultaneously exploring new areas of application (Head & neck and brain cancer) where the technology is also thought to have huge potential benefit.

Although a global effort to develop new cancer therapies continues, surgery will be the mainstay treatment for the near future providing means of eradicating cancer in a single intervention. However, surgery has to evolve with the changing population and disease demographics. National cancer screening programmes has seen a shift to earlier stage disease, opening up opportunities for minimally invasive surgery but this requires the development of appropriate surgical tools. This is particularly acute in endoluminal surgery, where current surgical tools are ill-adapted to the constrained operative environment. The impact of our research aims directly at addressing future cancer needs. It will provide surgeons with tools to facilitate minimally invasive and endoluminal surgery, with benefits in terms of reduced morbidity and improved preservation of function.

Public and Society:
Clearly there is direct benefit to society through better preservation of health and quality life of cancer patients, reducing the need for rehabilitation and supportive services. Our laser surgical device will radically improve the precision at which cancers can be removed, reducing the risk of complications and facilitating a return to normal function. Improved precision and more complete cancer removal will also reduce recurrence rates, which is a significant cost burden for healthcare systems and society.

Commercial sector:
Our consortium has 2 commercial partners perfectly positioned, through their key strategic aims, to benefit from exploitation of the technology. Additionally, our partners will be part of a new network of physicists, engineers and clinicians which is likely to lead new avenues for research that develop beyond the scope of the research project.

Renishaw has a large footprint in medical applications, including disease diagnosis and novel stereotactic procedures for neurosurgery, directly overlapping with this work. They have a track record of commercialisation of medical device technology with many products in clinical practice and have a strategic goal for growth in this area. As a global leader in manufacturing systems and the manufacture of high value components they have a wide customer base that provides further routes for exploitation. The laser tool will also compliment diagnostic technologies currently in Renishaw's product portfolio and pipeline.

Coherent have commercialised state-of-the-art laser systems across an array of applications, including underpinning research in biomedicine. Hence, they are a key stakeholder in this research, well placed to exploit demand for such laser systems. The development of a bespoke, highly precise laser surgery technique requires robust and cost-effective laser systems and hence, combined with the integrated optical interrogation technologies, will have significant cross-over with Coherent's product portfolio.

Our Impact plan is also geared towards exploitation outside our commercial partners, utilising links with the NIHR Surgical MedTech to establish new commercial opportunities. We will strengthen the UK PLCs reputation in developing next generation healthcare technologies and provide new opportunities for growth. Such a multi-disciplinary project will result in the associated staff and students developing as researchers, growing a unique multidisciplinary skillset which in turn will help maintain, support and grow the UK's high-tech economy.

Clinical and medical:
The proposal is focussed on impact within the medical field and although our focus is on colorectal, head & neck, and brain cancers, due to the demand for endoluminal and precision surgery, our platform will be transferable to other cancers and diseases where surgical precision is of paramount importance. Additionally, our innovation in tissue interrogation modalities that can be deployed endoscopically, , and co-aligned with the laser tool, is likely to be of benefit in other medical applications.