During surgery, tumor tissue is often difficult to identify. As a consequence, the surgeon can have difficulties with deciding which tissue should be removed and which tissue can be spared. If tumor tissue is left in the patient during surgery, a patient requires additional treatment after surgery. On the other hand, when healthy tissue is removed unnecessary this can cause avoidable morbidity and poor cosmetic result.

At the NKI-AvL, we developed and implemented a concept called image-guided surgery to improve surgical outcome in oncology. This innovative approach is concentrated around the three sequential steps within the surgical workflow:

Tumor localization

A surgical electromagnetic navigation system guides the surgeon with high accuracy towards the location of the tumor tissue while visualizing vital structures around the tumor. This allows the surgeon to find the tumor avoiding damage to critical structures.

Tumor treatment (surgical resection)

Smart surgical instruments with integrated optical technology in the tip of the instruments are used to characterize the tissue around the tumor. This enables to discriminate healthy tissue from tumor tissue in areas where the surgeon is unsure about the nature of the tissue.

Assessment of tumor treatment

Directly after tumor resection, the tissue is assessed with hyperspectral and multispectral cameras in the operation room. This to ensure that the margins of the resected tissue are free of tumor. If tumor tissue is present at the margin of the removed tissue, an additional resection can be performed immediately.

These technologies have been successfully translated – in close collaboration with Technical University Twente and commercial partners – from bench to bedside. Some techniques are currently introduced into the surgical workflow, while others are being evaluated within a broad range of surgical procedures and tested for efficacy and cost-effectiveness.