Smart Sensing for Surgery

Recent advances in surgery have made a significant impact on the management of major acute diseases, prolonging life and continuously pushing the boundaries of survival. Despite increasing sophistication of surgical intervention, complications remain common and poorly understood, contributing significantly to mortality and morbidity. Surgical site infections, catheter related sepsis, wound dehiscence and gastrointestinal anastomotic leakage are recognised complications following surgical interventions or invasive monitoring of critically ill surgical patients. Current methods for detecting these complications rely on episodic clinical examination with 'snap shot' laboratory testing. There is therefore a pressing need to develop new sensing technologies that can be seamlessly integrated with existing surgical appliances to provide continuous sensing and early detection of these adverse events, thus minimising post-operative infection, complication, and readmission. All these will also have a direct impact on healthcare economics, and more importantly the prognosis and quality-of-life of patients after surgery.

The proposed project is organised into three research themes: 1) Multimodal Sensing and Miniaturised Embodiment; 2) Active Sensing with Low Power Microelectronics; and 3) Data Inferencing and Stratified Patient Management. These research themes address key technical issues related to sensor design, miniaturisation, and self-calibration, as well as low-power on-node processing, inferencing, and clinical decision support. These research themes are connected by three clinical exemplars in surgical sensing with increasing levels of technical complexity. The vision is to develop smart sensors integrated with surgical appliances and to be inserted in close proximity to the surgical site, encased within surgical drains/catheters, or placed in locations to more seamlessly monitor the systemic inflammatory response. The devices will be implanted during elective surgery or at biopsy, interrogated wirelessly, and eliminated by natural processes, or routine removal of 'hosts' such as the drains or catheters. The research programme is underpinned by extensive experience of the team in body sensor networks and bio-photonics in healthcare. Through an integrated programme of engineering research and development of a novel real-time active sensing paradigm, the project aims to transform the care pathways for surgery with greater consideration on personalised treatment, system level impact, real-time response to complications, patient concordance and quality of life. We expect that the outcome of the research will help improve surgical workflows, support safe discharge and home/community-based recovery, reduce unplanned readmissions, and influence the future of healthcare policy.

The proposed project addresses some of the pressing, as well as long-term challenges faced by healthcare systems around the world including the NHS. Surgical site infection accounts for over 15% of all hospital acquired infections; anastomotic leakage is associated with morbidity, poor functional outcome, increased risk of death and local recurrence in cancer patients. They both challenge the model of early discharge of patients following new therapeutic regimes such as minimally invasive surgery. For cancer, greater precision in response detection through sensing would improve patient confidence in treatment efficacy and would augment clinical decision making through a more thorough appreciation of disease progression. The proposed project covers the entire development cycle from fundamental theory to clinical application, with new devices/platforms that will establish tangible clinical impact within the next 10 years, as well as concepts that will reshape the landscape of sensing technologies for years to come.

People - To stimulate creative and adventurous approaches that underpin the objectives of the project, we will actively encourage young researchers to spearhead and take ownership of blue-sky idea generation with direct clinical interaction. Secondment to industrial collaborators and across consortium partners will be arranged for all research staff. The team will also be encouraged to lead public dissemination activities and develop the necessary managerial, vocational and entrepreneurial skills for career progression.

Knowledge and Economy - Through technological innovation and effective collaboration with all project stakeholders, we will ensure effective knowledge transfer, and clinical translation with measurable clinical impact.

Commercial - The potential IPs to be generated range from licensing, platform development, and commercial spin-offs, to mixed independent exploitation of the basic technology developed. We already have strong support from the industrial partners of the project and will work with them to identify potential opportunities for commercial exploitation throughout the duration of the project. To this end, an IP advisory group will be formed to provide critical review and management/technical recommendations to the research team and to establish effective dissemination routes to both academic and industrial communities. Key project team members have already extensive experience in commercial exploitation of academic research. Such expertise is essential to the success of our exploitation strategies to ensure the long-term sustainability of the Centre.

Clinical - The impact of the proposed project to develop smart sensing for surgery will be demonstrated through certified devices with extensive in vivo validation. Uptake by the NHS and clinical partners will provide clinicians with data that provides the basis for changing clinical practice to improve patient outcomes. In partnership with Imperial's Centre for Health Policy, cost-effectiveness analysis will be conducted to demonstrate cost savings to the NHS.

Communications, Engagement and Society - Through clinical evidence, the project team will actively promote public awareness of our research and develop a shared vision for future healthcare. There will be significant patient and public engagement through conferences, science fairs and open days. In partnership with the Institute of Global Health Innovation (IGHI) at Imperial, we have an on-going programme of such events and the project team will work closely with the IGHI media team to use public lectures/exhibitions to maximise the potential impact of the project and its public engagement and to ensure interaction with and exposure of our work to young school children, who may wish to pursue a career in bioengineering.