A fluorescence guided steerable laser tool for precision resection of early stage cancers

用于精确切除早期癌症的荧光引导可操纵激光工具

• 批准号: EP/N02494X/1
• 负责人: Jonathan Shephard
• 金额: $ 80.08万
• 依托单位: Heriot-Watt University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FN02494X%2F1
• 关键词: fluorescence; guided; steerable; laser; tool

In the UK 40,000 people are diagnosed every year with colorectal cancer which carries a life-time risk of 1:16 for men and 1:18 for women. The National Bowel Cancer Screening Programme is proving effective, with a 16% survival benefit for screened individuals. Importantly, there has been a shift in the detection to earlier disease with screening colonoscopy picking up polyps in 40% of cases and cancers in 10% of cases. There is therefore a growing demand to remove these early precancerous/cancerous tumours by endoscopic means. However, the shift away from conventional surgery to endoscopic techniques presents challenges. Existing procedures using relatively cumbersome electrical cutting devices to apply heat to the tissue are challenging to perform due to restricted access and a lack of fine control for the surgeon. In some cases it is not possible to remove colonic lesions due to them occupying sites inaccessible to "forward facing" endoscopic excision methods. This results in a non-ideal procedure sometimes resulting in serious complications such as bowel perforation. Infrared lasers are attractive for surgery because the water in human tissue strongly absorbs this radiation. Additionally, "ultrafast" i.e. picosecond pulsed lasers deliver energy in such short pulses that thermal effects are minimal and tissue can be ablated with the resulting crater restricted only to the area on which the pulse was incident. Therefore, by precisely and flexibly delivering the energy to specific tumorous areas they can be cleanly removed minimising both damage to surrounding tissue and the risk of bowel perforation. Another advantage may come from improved haemostasis with laser ablation, reducing bleeding complications. Unfortunately, the use of lasers for endoscopic surgery has been severely limited due to the lack of a suitable flexible delivery system capable of handling the high intensities required. Through EPSRC funding we developed a new family of optical fibres that are ideally suited for laser surgery. In particular these fibres deliver wavelengths and pulse energies previously unattainable. They have a small diameter (scale of a human hair) and are highly flexible and open up new routes for minimally invasive surgical therapies where the action of the laser is required within the body. The fibres were shown to deliver infrared and ultrafast lasers with adequate power for the ablation of hard and soft biological tissue and are mechanically and chemically robust. They can be bent to very small diameters (a few mm) and significantly outperform the current state-of-art technologies for laser delivery in surgery. Additionally, new imaging techniques are emerging using molecules that specifically attach to, and mark, cancerous tissue. These marked tumours, when correctly illuminated, will fluoresce or "light-up" and stand out from healthy tissue. This is particularly useful for small, early stage, flat tumours that are not visible under standard illumination allowing them to be readily visualised aiding a precise surgical intervention. It will also facilitate complete eradication of the tumours, helping to avoid problems with tumour recurrence. Due to its precision (far exceeding that of thermal endoscopic tools) laser energy can exploit this function and accurately target tumours. Through our Healthcare Partnership we will realise the full potential of these fibres and create a novel steerable surgical tool guided by the fluorescent marker. Our partnership consists of experts in high power laser applications and biophotonics at Heriot-Watt University and clinical expertise at the University of Leeds. Renishaw Plc have strong commercial activity in medical applications and can exploit the technology and Edinburgh Molecular Imaging Ltd developed the novel fluorescence marker. Together we will exploit this technology to develop a life-saving colorectal surgical procedure transferable to other life-threatening conditions.

在英国，每年有4万人被诊断出患有结直肠癌，男性和女性的一生风险分别为1：16和1：18。事实证明，国家肠癌筛查计划是有效的，筛查的个人存活率为16%。重要的是，随着结肠镜检查发现40%的病例有息肉和10%的病例发现癌症，检测已经转向了早期疾病。因此，越来越多的人需要通过内窥镜手段切除这些早期的癌前/癌肿瘤。然而，从传统手术向内窥镜技术的转变带来了挑战。现有的使用相对笨重的电子切割设备将热量施加到组织上的程序具有挑战性，因为访问受限，并且缺乏对外科医生的精细控制。在某些情况下，无法切除结肠病变，因为它们占据了“前向”内窥镜切除方法无法触及的部位。这会导致不理想的手术，有时会导致严重的并发症，如肠穿孔。红外激光对外科手术很有吸引力，因为人体组织中的水强烈地吸收这种辐射。此外，“超快”，即皮秒脉冲激光以如此短的脉冲提供能量，以至于热效应极小，组织可以被烧蚀，所产生的陨石坑仅限于脉冲入射的区域。因此，通过精确而灵活地将能量输送到特定的肿瘤区域，它们可以被干净地移除，从而将对周围组织的损害和肠穿孔的风险降至最低。另一个优势可能来自激光消融改善止血，减少出血并发症。不幸的是，由于缺乏能够处理所需高强度的合适的灵活输送系统，激光在内窥镜手术中的使用受到了严重限制。通过EPSRC的资助，我们开发了一种新的光纤系列，非常适合激光手术。具体地说，这些光纤提供了以前无法达到的波长和脉冲能量。它们的直径很小(人类头发的大小)，具有高度的灵活性，为需要在体内进行激光作用的微创外科治疗开辟了新的途径。这些纤维被证明能够发射足够能量的红外和超快激光来消融硬的和软的生物组织，并且在机械和化学上是坚固的。它们可以弯曲到非常小的直径(几毫米)，大大超过目前外科手术中最先进的激光输送技术。此外，新的成像技术正在出现，使用的是专门附着和标记癌症组织的分子。这些标记的肿瘤，当正确照明时，会发出荧光或“发光”，从健康组织中脱颖而出。这对于在标准照明下看不到的早期扁平小肿瘤特别有用，使它们很容易被可视化，以帮助进行精确的外科干预。它还将促进肿瘤的完全根除，有助于避免肿瘤复发的问题。由于其精确度(远远超过热内窥镜工具)，激光能量可以利用这一功能并准确地靶向肿瘤。通过我们的医疗合作伙伴关系，我们将实现这些纤维的全部潜力，并创造出一种由荧光标记引导的新型可引导手术工具。我们的合作伙伴包括赫里奥特-瓦特大学的高功率激光应用和生物光子学专家以及利兹大学的临床专家。雷尼绍公司在医疗应用方面具有很强的商业活性，可以利用这项技术，爱丁堡分子成像有限公司开发了新型荧光标记。我们将共同利用这项技术来开发一种可以转移到其他危及生命的情况下的挽救生命的结直肠手术程序。

项目成果

Heat impact during laser ablation extraction of mineralised tissue micropillars.

• DOI: 10.1038/s41598-021-89181-9
• 发表时间: 2021-05-26
• 期刊: Scientific reports
• 影响因子: 4.6
• 作者: McPhee S;Groetsch A;Shephard JD;Wolfram U
• 通讯作者: Wolfram U

Novel optical technologies for ultrashort pulsed laser surgery

用于超短脉冲激光手术的新型光学技术

• DOI: 10.1117/12.2527081
• 发表时间: 2019
• 作者: Risbridger D

Effects of the process dynamics in picosecond laser ablation of soft tissues

皮秒激光软组织消融过程动力学的影响

• DOI: 10.1117/12.2610104
• 发表时间: 2022
• 作者: Beck R

Picosecond lasers for precision resection of soft tissues

用于软组织精密切除的皮秒激光器

• DOI: 10.1117/12.2624734
• 发表时间: 2022
• 作者: Shephard J

Dynamics of picosecond laser ablation for surgical treatment of colorectal cancer.

皮秒激光消融的动力学，用于进行结直肠癌的手术治疗。

• DOI: 10.1038/s41598-020-73349-w
• 发表时间: 2020-11-20
• 期刊: Scientific reports
• 影响因子: 4.6
• 作者: Beck RJ;Bitharas I;Hand DP;Maisey T;Moore AJ;Shires M;Thomson RR;West NP;Jayne DG;Shephard JD
• 通讯作者: Shephard JD