We developed new microscope technology to aid surgeons in improving operating procedures. These new instruments incorporate key adaptive optics (AO) technology, as developed in the ERC Advanced Grant programme AdOMiS. The therapy of choice in most malignant tumours in the human body is to attempt total resection with preservation of normal functional tissue, followed by radio-chemotherapy. Successful total resection relies on accurate intraoperative definition of tumour borders. An incomplete resection of a tumour with remaining infiltrative growing cells increases the risk of recurrence with adjacent therapies, decreasing the quality of life and shortening lifetime.
Unfortunately, the resolution, contrast and imaging depth of state-of-the art commercially available surgical confocal microscopes and endoscopes are not sufficient to differentiate healthy tissues from tumours at cellular resolution. Moreover, these methods are compromised by optical aberrations, such that imaging is limited to the superficial layers of cells. This makes it impossible to differentiate tumour from normal tissue on a cellular level, thus procedures rely upon slow and inconvenient biopsies and intraoperative histopathology. We have developed a new, compact, laser-scanning confocal microscope that provides easy access for surgical instruments. The incorporation of adaptive optical aberration correction in the design permits novel scanning mechanisms and better in-situ identification of tumour boundaries, particularly below the tissue surface. This will reduce the surgeon’s reliance on slow and often inaccurate biopsies, lead to increased success rates and minimise injury to normal tissue.
This proof of concept project has provided an operational prototype microscope that has been validated on tissue specimens. It forms the basis of an ongoing development plan that will see the technology translated into the operating theatre. The new approach to surgical microscopy would prolong patients’ lives, would lead to a reduction of post-operative treatment and a higher quality of life. With the proposed technology, complex and various tumours could be differentiated precisely and abnormal tissues could be gently resected. The utilization of adaptive confocal laser microscopy in the operating room could reduce surgical intervention time, help prevent injury to vital tissues and also help minimize tumor recurrence.
