Being a surgeon himself, Ruers regularly operates on colon cancer patients with liver metastases at the Netherlands Cancer Institute. Every time that’s a challenge, involving risks: “You want to cut with great precision: don’t leave any tumor tissue behind, without the margins getting too large. There are vital structures present in the liver – like blood vessels and bile ducts – that you’d rather not damage. But unfortunately it’s sometimes hard to see or feel the metastases. If you look at the liver, all you see is a brown surface.”
"Of course, we make CT and MRI scans beforehand," Ruers continues. That way, a surgeon literally gets a picture of the location of the metastases. But in the operating room, he still needs to search. “I can view the image on my surgical monitor, but I would love to see depth. And that’s what we are trying to achieve in this project: we want to turn the information from the scans into 3D models, and project these models onto the surgical monitor; a layer of extra information. Augmented reality, which allows you to see the anatomic structures you’re operating on in great detail.”
This would be a godsend for both patients and health care, he thinks. “With increased precision in surgery and fewer complications, you can really help your patient. And the idea behind this technique is that you plot out a line, where the surgeon can cut. That makes it so much easier to train people in these complex surgical procedures. It won’t be a matter of years of experience, like it is now.”
It’s a great vision for the future, but one that can cause impatience. The research has only just started and will take four more years. And we badly need that time, Ruers knows: “A lot needs to happen before we can use this technique in patient care. The technique, software, and surgical instruments will need to be developed. And you want to be able to make live corrections in case the liver moves – when touched, for example, or when the patient breathes. The 3D model needs to move along with the liver, which is complicated. That’s something we will be developing over the first years. If everything goes according to plan, we will be able to use this technique on patients over the final year of the project. We only just started, but we got the ball rolling. That’s very important. If it works, other parties will get involved and we can scale up: like the application in treatment of other cancer types, or its implementation in other hospitals.”
Besides his work as a surgeon at the Netherlands Cancer Institute, Ruers is also a professor at the University of Twente. In the clinic he spots the issues that the technicians at the university can help solve. “That’s one of the things I love about my job. I find inspiration in technological developments outside of the field of medicine. I love to attend conferences about subjects I know very little about. Sometimes you waste two hours in one of those meetings, but other times you gain a promising new idea.”
Another Dutch Cancer Society-supported project that Ruers is working on is a great example of such an idea: “We are looking into the application of a hyperspectral camera. This technique originated in geology and space travel, but we are now using it to improve breast cancer surgery. The field of medicine can learn a lot from things that are happening in the world around us!”
This article was originally published on the Dutch Cancer Society’s website (Dutch).