PreCisE: A Precision laser scalpel for Cancer diagnostics and Eradication

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The world's population is rapidly growing and, most importantly, at the same time is ageing. This provides a driving force for the increase in cancer, which is predicted to grow from 18.5M in 2018 to 29.5M in 2040. One of the most effective strategies to combat cancer has been the introduction of screening programmes, which enable the disease to be detected at an earlier stage when it is curable. Earlier stage disease also lends itself to minimally invasive and endoluminal surgery, with advantages in terms of reduced morbidity and better preservation of normal function. There is an acceptance that the use of minimally invasive and endoluminal surgery will continue to grow, perhaps in conjunction with robotic-assistance. But, to deliver this ambition, appropriate surgical tools need to be developed. This includes tools for real-time diagnosis of cancer that can be coupled with ablative and excisional modalities to eradicate the disease. Combined diagnostic and ablative tools will enable microscopic disease to be detected, particularly at cancer margins where infiltrative growth is difficult to distinguish from normal tissue. Failure to eradicate such microscopic disease is usually the cause for treatment failure and cancer recurrence. Our multidisciplinary team of physical scientists, engineers, laser specialists, and clinicians have begun to address this shortfall in surgical hardware precision by investigating a new laser-based approach ideally suited for minimally invasive and endoluminal cancer surgery. By employing "ultrashort" picosecond lasers, that deliver energy in a series of pulses only a few picoseconds long, we have demonstrated the ability to remove (ablate) tumours on a precision 2 orders of magnitude smaller than existing tools. Importantly, because the laser pulses are so short, there is no time for heat to diffuse into surrounding tissue, as is the case for existing surgical tools. Therefore, we have shown that damage to tissue around the surgical zone can be restricted to less than the width of a human hair - almost on the scale of individual cells.On clinically relevant tissue models we have demonstrated in the laboratory that this picosecond laser ablation could provide a step change in precision resection of the bowel and hence transform endoluminal colorectal cancer surgery. Additionally, we have shown that ps laser pulses can be flexibly delivered via novel hollow core optical fibres giving confidence that endoscopic deployment can be realised and opening up new areas of minimally invasive procedures.We now need to capitalise on this foundation and have therefore expanded our network of clinical expertise and identified new areas where our technology could be truly transformative. Neurosurgery is the ultimate test of precision, even microscopic loss of healthy tissue can have a huge impact on quality of life. In head and neck surgery, minimising resection of normal tissue allows functional preservation of speech and swallowing, positively influencing quality of life outcomes. In parallel, we aim to build on our successful results in colorectal cancer by developing novel strategies for incorporating real-time diagnostic imaging aiming towards clinical application. The proposal will take our understanding of lasers in colorectal cancer surgery towards clinical application, whilst simultaneously exploring new areas of application (Head & neck and brain cancer) where the technology is also thought to have huge potential benefit.