Terabotics - terahertz robotics for surgery and medicine

迫切需要提高针对几种高发癌症的外科手术的精确度、控制性和选择性。例如，在英国，自20世纪90年代以来，基底细胞癌（BCC）的发病率增加了约250%，每年有137，000例新的BCC病例。肠癌是第四大常见癌症，也是癌症死亡的第二大常见原因。大约15%的新肠癌病例是早期的，并且适合于潜在的腔内手术;随着国家筛查计划的实施，这一比例正在增加。肿瘤的延迟诊断和不完全切除是患者发病率的主要驱动因素，并浪费了有限的外科资源。随着新型冠状病毒肺炎（COVID-19，即2019冠状病毒病）导致更多患者积压，简化筛查和早期诊断流程变得更加重要。默认的手术实践是尽可能地切除癌症，沿着健康组织的边缘。留下癌细胞会导致复发，但切除过多的健康组织会增加并发症的风险和正常功能的丧失。试图优化这种平衡是一个全球性的挑战。例如，基底细胞癌通常在皮肤表面下扩散，使得它们的整体直到手术才能被检测到。Moh的显微外科手术是治疗BCC的金标准：肿瘤被逐节切除，并在显微镜下检查，直到没有进一步的肿瘤可以看到。这对患者来说既耗时又创伤，通常导致比预期更大的皮肤移植物。如果在手术前使用太赫兹（THz）成像可以准确地确定肿瘤的范围，手术将更快，移植物也会更好地规划。类似地，如果可以将诊断THz成像能力添加到柔性内窥镜中，则可以在原位识别更多的结直肠肿瘤并切除，而无需等待组织学结果（通常为2周）和随访程序。在这个项目中，一个高度跨学科的团队，由沃里克，埃克塞特和利兹大学的物理，工程和医学研究人员组成，并在考文垂和沃里克郡大学医院和利兹教学医院NHS信托，联手优化患者的诊断和治疗。该团队得到了包括TeraView Ltd、Intuitive Surgical、Kuka（世界工业机器人领导者）、QinetiQ、国家物理实验室和Lubrizol（国际化妆品公司）在内的行业合作伙伴的支持。太赫兹光是非电离的，使用低功率水平，使得热效应是微不足道的，因此对于人体的体内成像是安全的。它对分子间的相互作用（如氢键）非常敏感，并探测皮秒时间尺度上发生的过程。由于太赫兹光对组织水合作用和组成的高灵敏度，太赫兹光谱成像可以帮助定位和诊断其他成像方式无法看到的病变。在Terabotics，我们将把太赫兹技术集成到机器人探针中，以开发用于癌症检测和手术切除的改进平台。我们将开发可用于皮肤和腹腔的探头，通过验证该技术，我们还将开发一种用于机器人结肠镜检查的新型柔性探头。通过这种方式，该项目将导致更有效的癌症诊断和手术，节省外科医生的手术时间，减少所需的手术数量。这是因为在手术前准确地确定癌症的程度将能够更好地制定手术计划，并减少对第二次手术的需求。能够原位诊断癌症也将使诊断更快，治疗时间更短。这些因素将减少创伤，成本，患者积压和等待名单，并改善患者的结果。简而言之，我们在原位诊断方面的突破将在未来许多年内为癌症的检测和治疗带来重大变化。

There is a pressing need to improve the precision, control and selectivity of surgical procedures addressing several high-incidence cancers. For example in the UK, the incidence of basal cell carcinoma (BCC) has increased by approximately 250% since the 1990s, with 137,000 new cases of BCC each year. Bowel cancer is the 4th most common cancer and is the second most common cause of cancer death. Some 15% of new bowel cancer cases are early stage and amenable to potential endoluminal surgery; this proportion is increasing with national screening programs. Delayed diagnosis and incomplete excision of tumours are key drivers of patient morbidity, and squander limited surgical resources. Streamlining screening and early diagnosis processes is now even more important with more patient backlog caused by Covid-19. The default surgical practice is to remove cancers wherever possible, along with a margin of healthy tissue. Leaving cancer cells behind leads to reoccurrence, but removing too much healthy tissue increases both the risk of complications and the loss of normal function. Trying to optimise this balance is a global challenge. For example, BCCs often spread out beneath the surface of the skin such that their entirety cannot be detected until surgery. Moh's micrographic surgery is the gold standard for treating BCCs: the tumour is removed section by section and examined under the microscope until no further tumour can be seen. This is both time consuming and traumatic for the patient, typically resulting in larger skin grafts than expected. If the extent of the tumour could be accurately determined, using terahertz (THz) imaging prior to surgery, the procedure would be faster, and grafts better planned. Similarly, if a diagnostic THz imaging capability could be added to a flexible endoscope, more colorectal tumours could be identified in situ and resected without waiting for histology results (typically 2 weeks) and a follow-up procedure. In this programme, a highly interdisciplinary team consisting of investigators at Universities of Warwick, Exeter and Leeds in Physics, Engineering and Medicine, and at the University Hospital of Coventry and Warwickshire and the Leeds Teaching Hospitals NHS Trust, join forces to optimise patient diagnosis and treatment. The team is supported by industry partners including TeraView Ltd, Intuitive Surgical, Kuka (world leader of industrial robots), QinetiQ, the National Physical Laboratory and Lubrizol (an international cosmetics company). THz light is non-ionising, uses low power levels such that thermal effects are insignificant and is consequently safe for in vivo imaging of humans. It is very sensitive to intermolecular interactions such as hydrogen bonds, and probes processes that occur on picosecond timescales. Owing to the high sensitivity of THz light to tissue hydration and composition, THz spectroscopic imaging can help locate and diagnose lesions that cannot be seen by other imaging modalities. In Terabotics, we will integrate THz technology into robotic probes to develop improved platforms for cancer detection and surgical removal. We will develop probes that can be used on the skin as well as in the abdominal cavity and, by miniaturising the technology, we will also develop a new flexible probe for robotic colonoscopy. In this way the project will lead to more efficient cancer diagnosis and surgery, saving surgeons' operating time and reducing the number of surgeries needed. This is because accurately determining the extent of cancers prior to surgery will enable better surgical planning and reduce the need for a second surgery. Being able to diagnose cancers in situ will also give a faster diagnosis to treatment time. These factors will reduce trauma, costs, patient backlog and waiting lists, and improve patient outcomes. In short, our breakthrough in developing in situ diagnosis will bring step changes in the detection and treatment of cancer for many years to come.