‘The surgeons of tomorrow will operate with light as an extra sense’
In his inaugural lecture, Alexander Vahrmeijer, Professor of Surgery specialising in Molecular-targeted Precision Surgery, explained how light, fluorescence and smart technology are making surgery safer and reducing complications.
What is the main message of your inaugural lecture and why did you choose this topic?
‘Surgery is evolving from a field that mainly relies on experience and visible anatomy to one in which technology helps us to see more, understand better and treat more precisely. Fluorescence-guided surgery shows that we can literally see tumours, nerves and vulnerable structures in a different light. This will allow operations to become less radical and improve our patients’ quality of life.
‘With this technique, patients are given a fluorescent substance that accumulates in specific tissue, such as tumours or critical structures such as nerves or the ureter that need to be preserved. These then become visible during surgery using special cameras and infrared light. The surgical field is literally lit from within.
‘“Surgery in another light”’ is not only about seeing better during operations but also about learning to look differently at healthcare, collaboration and innovation. We can’t improve the healthcare of the future until we truly understand what we see.’
What research lines are you and your team working on?
‘A key part of our research focuses on procedures using fluorescence-guided surgery to make tumours and ureters more visible. These are being studied in clinical studies overseen by the American FDA and the European EMA.
‘We are also working on the development and improvement of fluorescent tracers: dyes that travel through the bloodstream to a tumour and light it up. The LUMC has a unique infrastructure for this, enabling us not only to develop these tracers in the lab but also to gradually prepare them for use in patients. We have made significant progress in this process in recent years.
‘New tracers are being developed by a team led by Stefan Harmsen and Lizzie de Muynck (Surgery), in collaboration with Paul Geurink, Jelle de Vries and Gerband van der Heden van Noort from the Cell and Chemical Biology (CCB) department.
‘Finding the best tracer is a time-consuming process. In the coming years, we aim to accelerate this considerably, supported by a research grant from the Hanarth Fund established by ASML. Together with Professor Gerard van Westen (LACDR) and Nada Badr (Surgery), we are using advanced AI techniques, also known as computational chemistry. A well-known breakthrough in this field is AlphaFold AI, for which the developers were recently awarded the Nobel Prize for Chemistry.
‘Collaboration with the hospital pharmacy is crucial for translating findings from the lab to the patient. We can also produce the tracers in accordance with GMP standards at the LUMC, so they can be safely administered to people. In an impressive facility, Rob Valentijn, Taryn March and Martin Pool are ensuring that these innovative tracers will actually become available to patients.
‘Once safety testing has been completed and the ethics committee has given us the go-ahead, the research will move to the Centre for Human Drug Research at the Leiden Bio Science Park. There, the new tracers will be administered for the first time to healthy volunteers. The clinical trial at the LUMC will start once these studies have been completed.
‘Currently, fluorescence is still assessed visually by the surgeon. This raises lots of questions, such as: how green is green? The next step in our research is to objectify these fluorescent images. Together with Denise Hilling and Britt Sticker, our AI expert, we are working on AI models that can quantify fluorescence, so that surgeons can be provided with even better information during operations.’
‘All these activities are closely aligned with the LUMC’s Academic Pharma programme.’
What role do teaching and healthcare play in your vision of this discipline?
‘Changing how we work in surgery is a big challenge. Not because we don’t want to innovate, but because new methods are only valuable if we learn to apply them properly. That takes structure, repetition and a safe environment in which people can learn new techniques and are able to make mistakes.
‘That’s why we need to train people differently – not just surgeons but the entire surgical team. And not only through theory, but primarily in practice, with simulations and immediate feedback. The whole team has to learn and train together. We’re developing this training with Johan van Wezel from Mobula B.V. at the Leiden Bio Science Park and are also organising hands-on courses, like the international ESSO-ISFGS course in Image-Guided Surgery.
‘But we’re not there yet. The challenge for the coming years lies in further professionalising our teaching and training, so that new surgical methods are not just developed, but actually reach the patient. Teaching isn’t a luxury; it’s the key to implementation. And implementation is what ultimately makes the difference for the patient. There’s no impact without implementation.
‘The nursing department also plays an important role. There is growing evidence that carefully applied LED lighting, which mimics the natural day-night cycle, can improve patients’ sleep quality, reduce stress and even alleviate pain. Green light in particular appears to have a potential pain-relieving effect.
‘By combining this with smart sensors that continuously measure sleep, heart rate and stress, we can tailor the hospital environment to the patient in real time, and possibly even identify complications before symptoms arise. We’ll be working closely with Bert Bonsing to improve patient safety on the ward while reducing the workload for nurses.’
Source: LUMC