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Dr Dickinson (Bioengineering) collaborated with Professor Habib (Surgery) to develop novel methods for removing or starving tumours. Resection (removing part of an organ) is theoretically an ideal method for treating liver cancer as the liver can regenerate, but it causes extensive blood loss. The Bioengineering team developed a bipolar electrode system that employs RF current to coagulate a track in the liver; the track can then be cut without bleeding. Prototypes were successfully tested in pre-clinical and clinical trials. 20,000 single-use devices (value: US$40M) have been sold under licence by AngioDynamics, with an estimated saving of >800 lives. Complications, intensive care, blood transfusions, and hospital stay have also been dramatically reduced. Dickinson developed further bipolar devices for maintaining the patency of ducts during pancreatic and biliary cancers, for ablating liver tumours and for blocking tumour blood supply. Sold by Imperial spin-out Emcision, these are also in current clinical use.
Impact: UoE-developed techniques to determine liver volume and define, pre-operation, the minimum liver remnant required have transformed the viability and success of liver surgery and stimulated commercial development of imaging software/hardware.
Significance: Precise functional liver volume measurement prior to surgery is now the standard of care and, for example, renders 85% of patients previously deemed irresectable to be resectable with a perioperative mortality of 2-4%.
Beneficiaries: Patients with liver cancer; the NHS and healthcare delivery organisations; imaging software/hardware companies.
Attribution: Pivotal studies were led by Wigmore and Garden at UoE.
Reach: Worldwide; technique recommended in guidelines in Europe, N America, Asia, Australasia; deployed in the management of 3600 patients per annum in the UK alone; the use of open-source software increases accessibility in developing world.
Questions about the benign or malignant nature of liver tumours are common and pressing since they determine how the patient is managed. Benign masses are frequently encountered; they usually do not require intervention but are easily mistaken for malignancies with conventional imaging methods. Work at Imperial College demonstrated that microbubble contrast agents have the special property of lingering in both normal liver tissue and in benign solid masses, whereas malignancies do not retain microbubble. The discovery of this property at Imperial has led to their use worldwide as a diagnostic tool. In 2012 NICE recommended their use as being cost-effective for this use.
A low-cost, efficient, blood cell salvage technology (HemoSep) has resulted from research carried out at Strathclyde between 2008 and 2013. The novel technology has been patented and licensed to Brightwake Ltd., who manufacture the device in the UK and market it through a global distribution network. HemoSep has now been used in clinical centres across Europe, North America, and South Africa since its commercial launch in late 2012. The use of the device has been shown to reduce the need for donor blood transfusions in open-heart surgical patients by at least 1 unit (450 ml) with an associated reduction in transfusion related complications such as heightened inflammatory response and bleeding. The reduction in blood transfusions associated with the use of HemoSep has a considerable cost benefit to healthcare providers (in North America blood costs up to $1600 per unit). In addition, commercialisation of HemoSep has led to the creation of new manufacturing, marketing and sales jobs in the UK and overseas.
University of Bristol researchers at the Bristol Heart Institute (BHI) have pioneered the development and clinical take-up of the novel technique of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical trials and several large cohort analyses have assessed the impact of this technique on elective and high-risk patients. The results have shown that it is as safe as the conventional coronary artery bypass grafting (CABG) technique that uses a cardiopulmonary bypass pump and cardioplegic arrest. Most importantly, however, OPCAB significantly reduces the risk of post-operative complications, and reduces morbidity and mortality. It also uses less hospital resources, reducing time in intensive care and length of hospital stay. In 2011 (the last year for which data are available), 20% of CABG operations in the UK were carried out with the OPCAB technique and it has had significant take-up overseas (for example, 18% of CABG operations in the US and 21% in the EU in 2010). NICE has recommended the safety and efficacy of OPCAB surgery.
Postoperative local recurrence affects 20-30% of patients with rectal cancer. Between 1993 and 2013, University of Leeds researchers identified the importance of pathology studies to show a disease-free margin around the excised tumour and how to predict this margin routinely and accurately using simple histopathology and preoperative MRI.
We also used photography in the pathological assessment of the quality of surgery and were instrumental in the adoption of modern techniques by professional organisations around the world.
Following adoption of our techniques in England and Scotland, local recurrence has halved with 10% better survival and cost savings of £60 million. Our methods have also become the gold standard in the treatment of rectal cancer patients around the world.
Professor Norman Williams and colleagues, based at Queen Mary, developed innovative surgical procedures for patients with anorectal diseases to preserve function, reduce morbidity, eliminate the need for a permanent stoma and reduce its complications. They tested these in clinical trials and showed them to be effective and improve quality of life. The APPEAR procedure (designed to preserve continence in patients who would otherwise require a permanent stoma) is now used internationally and electrically stimulated gracilis muscle (ESGN) is well established as a treatment for end-stage faecal incontinence (FI). The team has harnessed the science of neuromodulation to provide minimally invasive methods of treating FI and developed robust processes for technological development, training and dissemination. Two patents have been filed for innovative surgical instruments and these have been developed commercially.
Impact: Health and wellbeing; translation of a clear evidence base for reducing red blood cell use in intensive care and surgery into guidelines and changed clinical practice.
Significance: A 20% reduction in overall UK red blood cell usage between 2002-2012, saving the NHS approximately £100M annually; 7000 fewer patients are exposed to red cell transfusion annually, saving 500 lives.
Beneficiaries: Patients in intensive care units; the NHS and healthcare delivery agencies.
Attribution: Studies were led by Walsh at UoE with NHS and Canadian collaborators.
Reach: 7000 patients per year, UK-wide; incorporation into international guidelines.
Collaboration between Imperial College Departments of Mechanical Engineering and Surgery led to the development of active constraint robot solutions which augment surgeon skills so that joint replacement components are implanted accurately and successfully. This led to the founding of Acrobot to develop innovative surgical technologies. Acrobot was acquired by Stanmore Implants Worldwide in 2010. An orthopaedic stereotaxic instrument, based on Imperial research, obtained US Food and Drug Administration (FDA) clearance in 2013. This has led to Mako-Surgical purchasing Stanmore Implants Acrobot technology in April 2013.
Pulmonary arterial hypertension (PAH) is a fatal disease that typically affects women in their childbearing years. Professor Wilkins led a research team at Imperial College that identified phosphodiesterase type 5 (PDE5) as a drug target in the lungs of patients with PAH. Imperial validated the target in cell and animal models and demonstrated proof in patients that Sildenafil, a PDE5 inhibitor, was an effective treatment for PAH. Professor Wilkins conducted a clinical study to compare the effect of oral Sildenafil with Bosentan, the only other available oral therapy for PAH at the time. This study was the first, and remains the only, head-to-head study of two treatments for PAH. Sildenafil demonstrated comparable efficacy, had a greater effect on reducing cardiac mass (an integrated measure of heart work) and was well tolerated.
Sildenafil is now the most commonly prescribed drug for PAH. It is the most cost-effective, as judged by a technology appraisal initiated by NICE. National and international guidelines recommend Sildenafil as a first line treatment for patients in functional classes II and III pulmonary hypertension. Worldwide sales of sildenafil (Revatio®) for the management of PAH were $500m in 2010. With the expiration of the patent the cost of treatment will fall further.