Innovative equipment has been developed by New York’s Columbia University. Oncology surgeons will be able to obtain a real-time map of tumour tissues without having to take samples.
Oncological (and other) surgery could soon be subject to major innovations, thanks to a new microscope developed by bioengineers at Columbia University in New York.
The instrument appears able to reconstruct 3-D images in a non-invasive manner, making it possible to obtain vital information in real time (during surgery) from 'living' tissue that could radically alter the possibilities available to surgeons.
The new instrument is described in an article published in the scientific journal, Nature Biomedical Engineering in which the potential of MediSCAPE (an acronym for Swept Confocally Aligned Planar Excitation microscopy) is further highlighted by a series of video and images taken during tests.
Usually, when a biopsy is performed to determine whether or not a suspected tissue is cancerous, surgery is used to take a sample of the affected part, which is then fixed, cut and finally observed under a microscope. This takes a long time, and sometimes partial modification of the sample which has to be chemically treated for observation. In addition, there is always the risk that the sample is taken from a non-diseased area, perhaps next to the diseased one, and that the final result is not correct.
In the same way, direct observation is used to evaluate an organ or tissue for transplant.
There are some microscopes that can be used during surgery, but they offer a two-dimensional, and therefore limited, view at best and mean the patient has to ingest or consume a fluorescent tracer, which limits their use a great deal.
Images of the most hidden spots
All this may change with MediSCAPE, because if you can get 3-D images of an organ or tissue in situ, alive and performing its usual functions, you can see exactly what the situation is. What's more, you can observe a given point from every angle, including those at the back of the incision, which are often not visible to the naked eye. You can also check blood vessels to the capillaries to observe oxygenation, and study and identify the presence of malignant cells, which are physically very different from healthy ones.
MediSCAPE has an external probe that runs over the skin, detects signals and sends them to a computer. The computer then processes these signals and builds them into a 3D image, without the need for tracers, as it amplifies natural fluorescence - a huge improvement over all previous systems.
So far, this new instrument has been initially used with small creatures like worms and insects, then gradually in fish, rodents and increasingly complex animals. For example, one of the most interesting experiments was an exploration of the kidney of healthy rodents, which gave a very realistic overview of the tissues, as well as that of pancreatic tumours, which are extremely difficult to observe as a rule because they are located deep in the abdomen.
Mapping entire organs
In addition, by sliding the probe, it can go from a detail to a reconstruction of entire organs or tissues. This is a different kind of information, but just as important in terms of understanding the overall situation and also for anatomical study.
Finally, scanning can be very useful in robotic surgery, laparoscopic surgery (for example, to avoid touching nerves) and even in traditional biopsies: once the tissue has been removed, it can be analysed immediately, without the need for further steps.
The Columbia University team is now trying to develop a MediSCAPE that can be brought into the operating theatre, that is a suitable size and easy to sterilise. In the meantime, it has started the procedure for approval by the Food and Drug Administration (FDA), the organisation that regulates the testing of new drugs and diagnostic equipment in the United States.
