Minimally Invasive (keyhole) Surgery (MIS) is carried out through natural body openings or small artificial incisions. It achieves its clinical goals with minimal inconvenience to patients and results in reduced patient trauma, shortened hospitalisation, and improved diagnostic accuracy and therapeutic outcome. Despite its major advantages, MIS requires a high degree of manual dexterity from the operator as the restricted vision and lack of sensory feedback are major obstacles in MIS. The provision of in situ, in vivo morphological and functional imaging beyond the exposed tissue surface by video endoscope is essential for accurate surgical guidance and manipulation. The proposed RT-ISIS is to significantly enhance the consistency and safety of MIS, and further expand its functional capabilities in providing improved tissue detection, labelling, and targeting both at macro and cellular levels. These are particularly significant for applications such as minimally invasive cancer screening and treatment by permitting accurate determination of tumour margins in situ using large scale, non-contact, imaging based biopsies to avoid further metastases and cancer cell seeding. The morphological and functional ‘see-through’ vision provided by RT-ISIS will also accelerate the future development of intra-cavity and intra-luminal MIS where accurate imaging guidance is critical.
The major technical challenge of RT-ISIS is the provision of in situ multi-scale integration of laser induced fluorescence imaging with white-light endoscopic video under normal MIS where large-scale tissue deformation is present. It involves novel technical approaches to imaging hardware, real-time reconstruction, tissue characterisation, and miniaturised instrument design and integration. The objectives of the project include:
Development of multi-excitation violet laser induced fluorescence probe for fibre based multi-scale ‘optical biopsy’;
MEMS/MOEMS integration to allow for dual-mode (white-light/fluorescence) scanning endoscope for simultaneous morphological and functional mapping;
Real-time multi-spectrum image reconstruction and mosaicking for continuous tissue characterisation and margin assessment;
Automated image guidance and integrated morphological and functional mapping that cater for tissue deformation and instrument interaction.
The project is based on significant, complementary recent technical progresses of the partners in MIS (Karl Storz Endoscope), surgical imaging, biophotonics, and clinical MIS (Imperial and St Mary’s NHS). It will be supported by Association of British Healthcare Industries (ABHI), St Mary’s NHS Trust and Health Technologies KTN.