More precise cancer surgery thanks to innovative laser imaging

Innovative optical methods could soon make cancer surgery significantly more efficient and tissue-friendly. The Leibniz Institute of Photonic Technology (Leibniz IPHT) has developed a new laser probe for tumor surgery in collaboration with the company Grintech and the Department of Otorhinolaryngology at the University Hospital in Jena.

In an interview with MEDICA-tradefair.com, Prof. Jürgen Popp and Dr. Tobias Meyer-Zedler explain how the laser probe optimizes tumor management.

Prof. Popp, Dr. Meyer-Zedler, how does your new probe differ from existing technologies in cancer surgery?

Prof. Jürgen Popp: Our aim is to provide doctors with a tool that makes tumors visible in real time during an operation. The key advantage of our method is that we use optical methods that can precisely differentiate between tumor tissue and healthy areas. This is done by analyzing molecular vibrations and specific fluorescence signals based on naturally occurring fluorophores in the tissue, allowing tumor margins to be clearly delineated. The surgeon can therefore see exactly where to cut in order to preserve as much healthy tissue as possible.

What optical methods are used?

Popp: We use non-linear optical methods with pulsed lasers. These laser pulses can excite molecular vibrations in the tissue, which tells us where proteins, lipids or cell nuclei are located. In addition, we use two-photon auto-fluorescence and second harmonic generation to visualize specific naturally occurring enzymes or proteins such as NADH or collagen. These methods provide us with a wide range of chemical and morphological image information that goes far beyond what is possible in today's endoscopy with conventional white light imaging.

What role does artificial intelligence play in image analysis?

Dr. Tobias Meyer-Zedler: The images we generate contain an enormous amount of data that is difficult to interpret with the naked eye. This is where AI comes into play: we use deep learning methods and neural networks to analyze the image data in real time. Using a trained model, an algorithm recognizes where tumour tissue is located and immediately shows the surgeon the relevant areas. We are currently expanding our database to 200 patients in order to further optimize the algorithms and make the diagnosis more precise.

Could the laser also be used to remove tumors?

Meyer-Zedler: Yes, indeed. Our endoscope combines diagnosis and therapy. Once the image analysis has identified tumor tissue, a special femtosecond laser can specifically ablate this tissue. This is a highly precise procedure that specifically removes subcellular structures without damaging surrounding tissue. In contrast to conventional CO2 laser surgery, hardly any heat is generated, which means that the tissue is not burnt but directly converted into a gaseous state. This makes the method particularly gentle and precise.

Will the surgical incision be automated in the future?

Popp: At the moment, the incision is still made manually or with a CO2 laser. However, there are already robot-assisted systems such as the Da Vinci system, in which the surgeon operates at a console. Our vision is to integrate our laser probe into such robotic systems. This would make it possible to control the distance to the area to be treated optimally and work even more precisely. Ultimately, this would significantly expand surgical options and further improve patient care.

When could the technology be used in the clinic?

Popp: We are currently testing the probe on tissue samples and are working on clinical implementation. Approval for use in humans is more strictly regulated in Europe than in the USA, but we hope to receive the necessary approvals within the next six to nine months. The procedure could then be used for the first time in people with head and neck tumors.