Title: Preoperative Surgical Planning for Complex Cancer Treatment
Funder: Department of Health and Social Care

Abstract: Our aim is to provide accurate 3D anatomical information to surgeons and patients that will improve surgical outcomes, enhance treatment planning, and allow more patients to benefit from minimally-invasive procedures. Surgery is the mainstay treatment for abdominal cancer, resulting in over 50,000 surgeries annually in the UK. Up to 20% of surgeries have major complications, which can result in a 5x increase in costs. Pre-operative surgery planning decisions are made by radiologists and surgeons upon viewing medical scans, like Computed Tomography (CT). The challenge is to mentally reconstruct the patient s 3D anatomy from these 2D image slices, including tumour location and its relationship to nearby structures such as critical vessels. This is time consuming and difficult often resulting in human error and suboptimal decision-making. Minimally-invasive surgery, such as robotic surgery, is enabling complex organ-saving operations, and results in smaller wounds and reduced healing times for patients. However, during minimally-invasive surgery, surgeons can only rely on a small camera to navigate the body, making the operation high risk for complex cases. Therefore, careful preoperative planning using 3D patient models are becoming invaluable for surgeons, and will make minimally-invasive surgery more accessible and safer for patients. Innersight s software enables surgeons to generate a 3D model from a patient's scan, in minutes, allowing them to easily differentiate between anatomical structures, and precisely calculate excision margins to best plan and perform the procedure. The 3D model can also be used intra-operatively to help the surgeon easily identify vessels and locate tumours. This project will collect data on the safety and effectiveness of the technology, develop a commercialisation strategy, and improve product design. Objective.1 Gather clinical validation evidence and enhance adoption strategy. Quantify product clinical utility via a prospective clinical study. Trial patient 3D models at Multi-Disciplinary-Team meetings. Dissemination: Research paper reporting the prospective study results. Objective.2 Finalise business case for 3D surgical planning. Expand business plan: competitor analysis, SWOT analysis, risk register, route-to-market and revenue generation strategies. Recruit key surgical opinion leaders to use the software. Dissemination: Business plan suitable for follow-on i4i funding and seed raise. Marketing material for surgeons. Objective.3 User-interface software development. Design surgical model views (e.g. virtual slicing of models). Collaborate with hospital PACS teams on IT integration. Dissemination: Report on user performance (model generation time, tumour delineation accuracy). This proposal has been co-developed with a patient who underwent kidney surgery and has proposed: Bimonthly patient focus groups with post-surgery patients. Discussions on ethics and confidentiality issues; how best to present, and use the 3D models for consultation and improving patient understanding on their disease and treatment options. Demonstrating the 3D model usefulness as an educational tool by pre- and post-interview pathology understanding and anxiety questionnaires.

Lay abstract: Our aim is to provide accurate 3D anatomical information to surgeons and patients that will improve surgical outcomes, enhance treatment planning, and allow more patients to benefit from minimally-invasive procedures. Surgery is the mainstay treatment for abdominal cancer, resulting in over 50,000 surgeries annually in the UK. Up to 20% of surgeries have major complications, which can result in a 5x increase in costs. Pre-operative surgery planning decisions are made by radiologists and surgeons upon viewing medical scans, like Computed Tomography (CT). The challenge is to mentally reconstruct the patient s 3D anatomy from these 2D image slices, including tumour location and its relationship to nearby structures such as critical vessels. This is time consuming and difficult often resulting in human error and suboptimal decision-making. Minimally-invasive surgery, such as robotic surgery, is enabling complex organ-saving operations, and results in smaller wounds and reduced healing times for patients. However, during minimally-invasive surgery, surgeons can only rely on a small camera to navigate the body, making the operation high risk for complex cases. Therefore, careful preoperative planning using 3D patient models are becoming invaluable for surgeons, and will make minimally-invasive surgery more accessible and safer for patients. Innersight s software enables surgeons to generate a 3D model from a patient's scan, in minutes, allowing them to easily differentiate between anatomical structures, and precisely calculate excision margins to best plan and perform the procedure. The 3D model can also be used intra-operatively to help the surgeon easily identify vessels and locate tumours. This project will collect data on the safety and effectiveness of the technology, develop a commercialisation strategy, and improve product design. Objective.1 Gather clinical validation evidence and enhance adoption strategy. Quantify product clinical utility via a prospective clinical study. Trial patient 3D models at Multi-Disciplinary-Team meetings. Dissemination: Research paper reporting the prospective study results. Objective.2 Finalise business case for 3D surgical planning. Expand business plan: competitor analysis, SWOT analysis, risk register, route-to-market and revenue generation strategies. Recruit key surgical opinion leaders to use the software. Dissemination: Business plan suitable for follow-on i4i funding and seed raise. Marketing material for surgeons. Objective.3 User-interface software development. Design surgical model views (e.g. virtual slicing of models). Collaborate with hospital PACS teams on IT integration. Dissemination: Report on user performance (model generation time, tumour delineation accuracy). This proposal has been co-developed with a patient who underwent kidney surgery and has proposed: Bimonthly patient focus groups with post-surgery patients. Discussions on ethics and confidentiality issues; how best to present, and use the 3D models for consultation and improving patient understanding on their disease and treatment options. Demonstrating the 3D model usefulness as an educational tool by pre- and post-interview pathology understanding and anxiety questionnaires.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;6.4 SURGERY
Health categories: CANCER AND NEOPLASMS