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Real Time Cancer Prediction Based on Objective Tissue Compliance Measurement in Endoscopic Surgery

Fakhry, Morkos PhD; Bello, Fernando PhD; Hanna, George B. PhD

doi: 10.1097/SLA.0b013e31828ccf43
Original Articles

Objective: To investigate the feasibility of real time cancer tissue diagnosis intraoperatively based on in vivo tissue compliance measurements obtained by a recently developed laparoscopic smart device.

Background: Cancer tissue is stiffer than its normal counterpart. Modern forms of remote surgery such as laparoscopic and robotic surgical techniques diminish direct assessment of this important tissue property. In vivo human tissue compliance of the normal and cancer gastrointestinal tissue is unknown. A Clinical Real Time Tissue Compliance Mapping System (CRTCMS) with a predictive power comparable to the human hand and useable in routine surgical practice has been recently developed.

Methods: The CRTCMS is employed in the operating theater to collect data from 50 patients undergoing intra-abdominal surgical interventions [40 men, 10 women, aged between 32 and 89 (mean = 66.4, range = 57)]. This includes 10 esophageal and 27 gastric cancer patients. A total of 1212 compliance measurements of normal and cancerous in vivo gastrointestinal tissues were taken. The data were used to calibrate the CRTCMS to predict cancerous tissue in a further 12 patients (3 cancer esophagus and 9 cancer stomach) involving 175 measurements.

Results: The system demonstrated a high prediction power to diagnose cancer tissue in real time during routine surgical procedures (sensitivity = 98.7%, specificity = 99%). An in vivo human tissue compliance data bank of the gastrointestinal tract was produced.

Conclusions: Real time cancer diagnosis based on in vivo tissue compliance measurements is feasible. The reported data open new avenues in cancer diagnostics, surgical robotics, and development of more realistic surgical simulators.

Supplemental Digital Content is Available in the Text.A recently developed computerized system is employed to report and predict the nature of in vivo human tissue compliance and normal and cancer gastrointestinal tract tissue based on objective tissue compliance measurement. Its real-time cancer tissue prediction power during routine surgical practice is demonstrated to be of 98.7% sensitivity and 99% specificity.

From the Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY, UK.

Reprints: George B. Hanna, PhD, Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London W2 1NY, UK. E-mail:

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Disclosure: This work was supported by a grant from BUPA foundation (Grant No. PC3270). The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.