Surgical Technology and Artificial Intelligence

Increasingly, surgery is being performed by means of minimally-invasive approaches using high definition cameras. These laparoscopic or robotic procedures contain a wealth of video data which can be used to predict outcomes through the use of intelligent algorithms. Our lab has expertise in harnessing artificial intelligence techniques and using them with surgical video data to recognize optimal practice and help predict error. We are actively studying these techniques across a number of different surgical procedures. 

Virtual Reality and Augmented Reality in Surgery

The use of complex imaging technology can greatly improve management in surgery. This encompasses cancer and non-cancer conditions. Specifically, I have a research interest in complex imaging modalities that can better guide surgery to improve outcomes and how this can be incorporated into virtual and augmented reality models to improve training and execution of surgery. This includes stereotactic surgery to improve surgical precision in colorectal cancer and inflammatory bowel disease. Using these technologies, we will be able to develop more complex platforms to rehearse surgery and ultimately become more accurate in our ability to remove disease. Much of this work is conducted in conjunction with my cross-disciplinary colleagues at UCL including the School of Engineering and Robotics/Haptics. 

Fluorescence-guided Surgery

There is increasing use of fluorophores to improve surgical and oncological outcomes. Through a competitive funding application, I have been able to acquire a specific laparoscopic camera system which is able to excite Indocyanine Green (ICG) and demonstrate near-infrared fluorescence in the vascular and lymphatic system. I am currently involved in Phase I, II and Phase III trials looking at how the use of fluorophores can improve patient outcomes in laparoscopic surgery. The use of fluorophores will greatly improve our surgical precision in the future in conjunction with complex imaging modalities which can be integrated into laparoscopic and robotic platforms. To this end I am involved in the research and design of upcoming platforms with commercial partners.

Imaging Biomarkers

The management of rectal cancer has been greatly enhanced by a better understanding of disease progression and spread. Whilst precise surgical technique has led to historically low rates of local recurrence, the challenge of distant disease recurrence and ultimately, overall survival still remain. By relating predictive and prognostic tumoural characteristics that are accurately identifiable on non-interventional modalities such as MRI to tumorigenic pathways, novel therapeutic pathways may be exploited for optimal patient management. Working with the Royal Marsden Hospital, Imperial College London and MERCURY Research Group led by Professor Gina Brown and Professor Paris Tekkis, I have been able to relate a specific adverse phenotypical feature of rectal cancer, namely extramural venous invasion (EMVI) to specific patterns of disease recurrence and specific behavior to oncological therapy.