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Will a 'Smart Scalpel' Change Cancer Surgery?

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WebMD Health News

March 23, 2000 (Minneapolis) -- When removing cancerous tissue, particularly from the brain, surgeons face a dilemma. They want to remove the tumor completely but save as much normal tissue as possible. And patients want to avoid the multiple biopsies or surgeries that would be necessary if the entire tumor was not removed.

The solution may be a computerized laser device that instantaneously can detect which cells are cancerous cells and which are normal while the patient is still on the operating table.

Researchers at Sandia Laboratories, a Department of Energy laboratory based in Albuquerque, N.M., say the device, which they call a 'smart scalpel,' would let the surgeon know the moment that all the malignant tissue has been removed. They released information about the device, currently in experimental form, here at the annual meeting of the American Physical Society, a scientific research organization.

"This would allow surgeons to remove less tissue, and yet give the surgeon confidence that a tumor has been completely [removed]," Paul Gourley, PhD, tells WebMD. He is a member of Sandia Laboratories' technical staff and team leader for the project.

Also called a biological microcavity laser or biocavity laser, the device can tell between cancerous and normal cells by using a vertical laser beam that enters individual blood cells that have been pumped into channels in the device's glass surface.

Malignant cells are denser than normal cells because they contain more protein; therefore, the device detects the presence of these cells by a refraction, or bending, of the laser light that differs from that expected in healthy cells. These changes are in turn transmitted to a laptop computer that lets the surgeon know when the device has begun to detect blood cells that are from normal tissue. The investigators intend for the laser device, which is approximately the size of a dime, to be placed in the scalpel handle. Fluid from the incision would be suctioned by another attachment into the laser.

"Although its most critical application would be in neurosurgery, it could probably be used also in breast and prostate cancer," Gourley says.

However, others think the device would benefit brain surgeons the most. "It does sound useful to neurosurgeons, because it is harder to distinguish normal brain [tissue] from tumor," Jed Nuchtern, MD, tells WebMD. But "this device is of limited value to general surgeons or general pediatric surgeons [because] tumor [edges] are normally fairly obvious to the naked eye, based on color and consistency," he says. And because general surgeons try to take out an area of normal tissue around the tumor in order to be sure that the entire tumor is removed, "no one would want to get close enough to the tumor to start cutting across it with the 'smart scalpel,'" says Nuchern, who is a staff surgeon at Texas Children's Hospital in Houston.

The developers also hope that the device will have clinical applications beyond cancer surgeries. For example, the device can detect sickle cell anemia. Beyond medicine, they hope it can be used to monitor groundwater, waste fluids, or explosive chemicals. Another 'smart scalpel' laser device that has been explored by other investigators was targeted for the treatment of 'port-wine stain' birth marks.

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