Operating room: From DoD grant to fiber optic laser scalpel

What began at MIT with a Department of Defense grant for stealth research led to the world's most precise optical laser scalpel. A former surgeon and exec at what is now the MIT spin-out talks about the technology that's taking on deafness, brain tumors and oral cancers.

None of us look forward to being cut open. But next time “minimally invasive surgery” is on my to-do list, I will look forward to finding a surgeon who uses the OmniGuide technology--bloodless, no-touch, super-precise surgery.

The OmniGuide BeamPath, manufactured in Cambridge, Mass., is a flexible fiber system that uses carbon dioxide laser energy for the most delicate of surgeries (think brain tumors, throat cancers and deafness; see videos of these surgeries here).

The demonstration of this multi-layer fiber technology, developed at the Massachusetts Institute of Technology, was published in Nature and Science in 2002. (The Department of Defense, interested in the technology from a stealth standpoint, was an early funder.) Last week I talked to Dr. Yair Schindel, the company’s vice president of marketing, clinical affairs and business development and a former chief medical officer with the Israel Defense Forces Navy Seals.

It’s hard for me to imagine surgery that doesn’t involve a scalpel, yet with your BeamPath technology, you’re using lasers and fiber optics to make very precise incisions. How does it work?

You have a fiber optic device that looks like a hollow guitar string that can be snaked through a flexible endoscope or through [tools] that the surgeons hold in their hands. So this guitar string has a hollow core through which we transmit carbon dioxide laser energy. It evaporates tissues [with an intense beam of light] and coagulates blood at the same time. So it gives you the effect of bloodless surgery.

There are many devices that do tissue cutting and ablation, and there are different types of lasers. The special thing about this CO2 laser is that it’s considered the most precise optical scalpel out there. We measure things in precision microsurgery in collateral damage we cause the tissue, and most devices cause significant damage—some in centimeters, some in millimeters. The CO2 laser causes thermal injury in the tens of microns range.

So when you talk about a high level of precision, like a brain tumor, all we want to damage is the cancerous tissue. We don’t want to damage a healthy brain. Same for throat cancer and the vocal chords or certain kinds of deafness. You use the laser to cut out the stapes bone [in the ear] and replace it with a tiny prosthesis that vibrates. The KTP laser was the gold standard for this surgery until OmniGuide introduced the CO2 laser. When you use the CO2 wavelength your hearing results are much better.

How far away do you hold the laser from the tissue?

The endoscope is a millimeter away. But you can decide how close you want to be by just moving your hand. Since the beam has a bit of a divergence coming out of the fiber—like a flashlight--it can be used as a very precise scalpel if you’re close. If you move your hand away, your size of the laser spot will increase, and it will be in more of a coagulation mode.

You’re a former surgeon. Tell me how it feels to use the laser compared to traditional surgical methods.

It’s very intuitive. In many cases, we use these customized pieces in our hand as a pencil. There’s a short learning curve just to control the laser energy and to use it as intuitively as I would a scalpel. Usually in surgery, right after you cut, you have to use a coagulating tool to stop the bleeding. With this, you’re combing two tools into one. In many surgeries this translates to significant time and cost savings in the operating room. It also reduces the recovery time.

How is the BeamPath come about?

The CO2 laser has been around for over 30 years. The problem was that this specific wavelength could never be transmitted through a flexible delivery system. So even though in surgery it’s considered by far the most precise, bloodless scalpel, there was no way to get it into the body where access was an issue. The only way to fire it was in a straight line of sight.

A group at MIT came up with a way to transmit CO2 lasers through flexible fibers, so they don’t have to manipulate the patient and can make cuts with a precise manner. There are many places in the body where we need precision and don’t want to cause injury to other [healthy] structures nearby.

Today the technology is already used in over 300 hospitals in the U.S. and starting to go into Europe. There have been over 20,000 surgical procedures--like mouth, tongue and throat cancer, brain and spine surgery and ear surgery--without single adverse event.

The flexibility of the fiber is the thing that really differentiates this tool. What allowed you to do that?

The magic behind this technology lies in the perfect mirror that’s lining these hollow fibers from within. These fiber optics are different from conventional fiber optics. Normal fiber optics have a solid core inside. The solution [from the MIT group] was to take out the solid core and line the fiber from within with a multi-layer mirror that acts as a reflector for the CO2 laser wavelength. Today, 30 to 40 layers make up this perfect mirror. Each layer is only 1 micron thick, and the entire fiber is only 1 one millimeter in outer diameter. The hollow core is about 300 microns. Nobody thought this could be done. The company was founded in 2000 and it took until late 2006 before we were really able to manufacture the functional fibers small enough.

How much does it cost?

The fibers are around $1,000. The other piece is the laser source—the CO2 laser box. The box is around $70,000.

Did you model the BeamPath after technology in another industry?

The telecommunications industry is where fiber optics is used the most, but the wavelength is a lot shorter. OmniGuide has applications in many other industries, including the defense industry. One MIT grant came from the Department of Defense. They were looking for this perfect mirror for the stealth industry. That was the first minimal funding we received. Since then there has been almost $80 million of private financing that was put into the company. In December 2009 the company reached a break-even point and started becoming profitable.

Your company is 10 years old. What do you expect in the next decade?

We’re going to branch out to additional clinical applications where precision microsurgery is important and patient outcomes can be improved. We’ll see a coupling between [robots] and flexible fibers. When you use a robot, like Intuitive Surgical’s da Vinci, it enables great visualization and stability, so there’s no tremor, but they still use soft tissue-cutting tools that are very aggressive and cause thermal damage. So by coupling with the flexible fibers, you are doing less damage in the procedure.

Images: OmniGuide

This post was originally published on Smartplanet.com

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