Will a 'Smart Scalpel' Change Cancer Surgery?
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
"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
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.