PreCisE: A Precision laser scalpel for Cancer diagnostics and Eradication
Lead Research Organisation:
Heriot-Watt University
Department Name: Sch of Engineering and Physical Science
Abstract
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.
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.
Planned Impact
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.
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.
Organisations
Publications
Ehrlich K
(2023)
A miniature fiber optic ablation probe manufactured via ultrafast laser inscription and selective chemical etching
in APL Photonics
McPhee S
(2021)
Heat impact during laser ablation extraction of mineralised tissue micropillars.
in Scientific reports
Risbridger D
(2022)
Comparing Bessel-Gauss and Gaussian beams for ultrashort pulsed laser surgery
Shephard J
(2022)
Picosecond lasers for precision resection of soft tissues
Tye C
(2024)
Photon counting fibre optic distributed temperature sensing with a CMOS SPAD array
in Optics Express
Wolfram U
(2022)
Multiscale mechanical consequences of ocean acidification for cold-water corals.
in Scientific reports
Description | BBC Radio Scotland Interview |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Media (as a channel to the public) |
Results and Impact | Live interview on BBC Radio Scotland to discuss the latest results and describe the potential impact on the treatment of cancers (BBC Radio Scotland: Good Morning Scotland, 25/01/21) |
Year(s) Of Engagement Activity | 2021 |
Description | MRC Technological innovation for understanding cancers of unmet need |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Supporters |
Results and Impact | Sandpit to develop high risk projects fro feasibility funding via the MRC. Brought together people from disparate backgrounds to develop novel technological solutions for unmet cancer needs. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.ukri.org/opportunity/technological-innovation-for-understanding-cancers-of-unmet-need/ |
Description | The Evening Standard Tech & Science Daily Podcast |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | Interview on The Evening Standard Tech & Science Daily Podcast (Jan 21) about the latest results from our grant and the future perspectives. |
Year(s) Of Engagement Activity | 2021 |