What might cancer surgery look like in the future?

Q: What do you think the future of robotic surgery might look like? 

Performing an operation, remotely from anywhere in the world

Robotic surgery is undertaken by surgeons using a console to control the arms of the robot. Currently surgeons use these consoles whilst in the same room as their patient, but could this change in the future? 

“In the future I think there'll be much more remote surgery” says Mr Asif Chaudry, Consultant Upper GI/Oesophagogastric Surgeon. “So, we can sit in a different room or be anywhere in the world and then actually control and support the movements of a robot inside a patient elsewhere. It might be the case that experts in one part of the world might be able to support operations elsewhere in the world!”

From macro to micro - the scaling down of surgical technology and tools 

With the increasing focus on precision and minimally invasive techniques made possible by robotics, some of the research taking place currently is looking at how cancer can be treated with microscopic tools and technology.  

“There are new areas of microsurgery, which would have been very difficult without the advent of robots” says Professor Andy Hayes.

Microsurgery is a highly specialised surgical technique that involves operating on extremely small structures, often using microscopes and miniature instruments. By working on such a small scale, microsurgery enables surgeons to perform highly intricate procedures.  

But what if we could make technology like surgical robotics smaller too? Work is already under way around the world to develop ‘micro-robots' that can navigate inside a patient to detect and operate on tumours. 

“Technological advancements happen at an exponential pace” says Professor Vin Paleri. “I think we're going to see a significant change. In some of the work we are doing within the animal model, we have a micro-robot that can see, that can smell tumours and can cut tumours. So, translating that to humans is just a matter of time.” 

A shift to ‘soft robots’ 

“There is also a big move to develop what we call soft robotics” says Mr Asif Chaudry.

“In the future, I think robots are going to become a lot softer, so not these big metallic, hard, high-energy contraptions."

Soft robotics will be newer types of robots that actually mimic animals and their limbs, that can change their structure and shapes. This will be in a miniaturised form, so they can access the nooks and crannies, internal structures and organs against the contours of the body.” 

Q: What other technology could change cancer surgery in the near future? 

“Great progress is being made in cancer surgery and in terms of what we can deliver for our patients, it is getting better and better. New technologies already exist and there are many that are yet to come into this space.”  

Mr Asif Chaudry, Consultant Upper GI and Oesophagogastric Surgeon

‘Interactive operations’ using augmented reality 

"Looking ahead, cancer surgery is going to be improved by innovations in intraoperative guidance” says Mr Myles Smith, Consultant Surgical Oncologist and General Surgeon.  

Intraoperative guidance, or ‘Image guided surgery’ is the use of real-time imaging techniques during a surgical procedure. Some examples already used today are real time use of MRIs or CT scans during surgery. However, there is also lots of research currently underway at The Royal Marsden to develop new ‘surgery guiding’ techniques to assist in the operating theatre. One of these areas of research is exploring augmented reality (AR).  

“Thanks to funding from The Royal Marsden Cancer Charity, I’m currently investigating the use of augmented reality (AR) and mixed reality (MR) technology to support procedures and train future generations of surgeons” says Mr Smith.  

Using holographic models for planning operations 

Using existing imaging technology such as CT or MRI scans, surgical teams may soon be able to use AI to build 3D hologram models of patients or their anatomy to plan surgery or explain procedures to patients more easily.  

“One of the recent innovations in imaging technology is the development of holographic imaging” says Mr Smith. “You're able to take a CT, MRI or PET scan and annotating it manually or using AI create 3D hologram models of a patient." 

“What that means is we're able to generate models that we can look at and take apart. We could do things like define the anatomy and work out the relationships of the tumour to that particular anatomy. We could potentially use that to plan and guide surgery."

"For certain cancers, it's going to be fantastic to be able to take things apart because there's limits to what you can do with a CT scan and what your brain can conceptualise so to be able to actually put that together in 3D, we think would be very helpful. It'll also be helpful for trainees and very helpful for patients to be able to show them holographic images of what we'll do.” 

Lighting the way with Fluorescence guided surgery

By using special dyes that stick to specific targets, like cancer cells, surgeons can make tumours fluoresce or ‘glow’. The aim is to help surgeons find the margins of the cancer with higher precision while leaving healthy tissue untouched.  

“Fluorescence guided surgery is another hot topic” says Mr Smith. “You can cause the tumours to fluoresce and that may help guide surgery."

"This method allows surgeons to enhance the visibility of cancerous tissues during the operation. It involves probes that light up anatomy, or particular targets, providing real-time guidance during surgeries."

"It's something we already do routinely for certain types of operation, but I think that it's going to become widely used in surgery going forward. The Royal Marsden Cancer Charity’s support is helping us to develop specific probes and techniques for different types of cancer.” 

Q: What other trends do you expect might happen for cancer treatment in the future?

“I think in 20 to 50 years there'll be a lot of cancers that simply won't need operations anymore” says Professor Asif Chaudry.

“This is because we'll either discover them far earlier at a point in which more effective drugs might help with eradicating the disease, or preventative measures might even stop cancer from occurring.” says Professor Chaudry.  

Gene and cellular therapies are another exciting avenue for cancer treatment that might reduce the number of people needing surgery. 

“I think you're going to have trials like that continuing to try and reduce the amount of surgery” says Mr Myles Smith. “Thanks to research into genomics, there has been a paradigm shift in our understanding of how to treat cancer."

"New technologies, such as next generation sequencing (NGS), allow us to more accurately classify the molecular makeup of tumours and find drugs to target them.”    

“The future of cancer care is bright” says Professor Vin Paleri. “We are constantly pushing boundaries. We're doing things we never thought we could do even a decade ago. We are exploring new arenas and avenues that weren't even thought of 20 years ago. So I think give it another ten years. We'll be doing things that will be truly the future.” 

The importance of investing in research 

You don’t need to be a patient at The Royal Marsden to benefit from the research and innovation taking place here. The research that takes place at The Royal Marsden leads to the development of new surgical techniques, and improvements to existing methods that are adopted by surgeons worldwide. This progress changes the lives of cancer patients at The Royal Marsden, across the UK and around the world.  

With 1 in 2 people expected to develop cancer during their lifetime, our teams need to continue to push the boundaries to go even further for people with cancer. 

This would not be possible without the vital funds raised by the generous supporters of The Royal Marsden Cancer Charity.   

Make a donation today or discover more ways to support us.