Intra-operational tissue assessment is a key enabling technology for minimally invasive surgery. Surgeons operating along a "keyhole" or similar means of access for minimally invasive surgery need to identify different structures or diseased areas, even when these all may look similar. This work is aimed at identifying the resection margin in cancer surgery, to allow the removal of a tumour together with a margin which is just enough to ensure complete cancer excision, but without unnecessary excess tissue removal. Currently, such a surgical margin is identified using a combination of the surgeon's experience, images of various kinds taken prior to the operation coupled with any visual observations, or tactile 'feel' in the scenario of open surgery, that the surgeon can make during the operation. Ultimate confirmation of the surgical margin relies on post-operative histopathology, where the removed tissue is assessed microscopically. Only then, will it be known if the removal has been successful or if further surgery and/or more aggressive post-operative treatment is required. These challenges are particularly acute in surgical removal of tumours from the rectum and some pelvic organs, where wider surgical excision is constrained by close proximity of anatomical structures with high functional importance, e.g. nerves and vasculature supplying bladder, bowel, sexual organs and lower limbs. The development of minimally invasive techniques (such as laparoscopy or operations along body ducts, such as in the rectum or colon) have removed surgical 'feel' for tissue characteristics, including assessment of surgical margin. This highlights an unmet clinical need for a quantitative, robust, reliable and evidence-based method of determining the optimal surgical margin and providing feedback to the surgeon in a way that it can be used to make decisions during the operation. Robot-Assisted Surgery (RAS) is the next development in minimally invasive surgery and has seen rapid development in treatment of a wide variety of conditions. It offers improved clinical accuracy by giving surgeons better control of instruments and providing features such as 3D visualisation. Such developments are particularly useful in confined spaces such as the pelvis and rectum. So far, RAS has found limited application in oncological surgery, mostly because current RAS systems rely almost entirely on visual feedback, and do not provide support for clinical decision making. This work aims to provide a novel function in RAS to enhance intra-operative clinical decision making. This technology would accelerate development of RAS in many types of visceral and solid-organ surgery where visual feedback is limited or inadequate to determine surgical margins reliably. This partnership brings together 4 distinct and complementary engineering groups with two clinical specialisms and is supported by two industries, an SME in the medical sensors area and a manufacturer of surgical robots. The group will focus on two principal aims: 1. to devise a microfabricated probe deployable via a standard minimally invasive surgery instrument capable of making intra-operative mechanical measurements on the tissue surface. 2. to establish data modelling methods in order to process the real-time measurement data to produce quantitative assessment of surgical margin as intra-operative feedback to the surgeon. The approach will be developed in a staged series of trials, including on ex vivo human tissue and in vivo animal models, with ultimate demonstration in a surgical environment. Through the work, the partnership expects to develop a unique and future-proof 'RAS-made-smarter' technology for applications in intra-operative identification of tumours and tumour margins and, by extension, in other surgical areas.

Our EPSRC CDT in Advanced Engineering for Personalised Surgery & Intervention will train a new generation of researchers for diverse engineering careers that deliver patient and economic impact through innovation in surgery & intervention. We will achieve this through cohort training that implements the strategy of the EPSRC by working across sectors (academia, industry, and NHS) to stimulate innovations by generating and exchanging knowledge. Surgery is recognised as an "indivisible, indispensable part of health care" but the NHS struggles to meet its rising demand. More than 10m UK patients underwent a surgical procedure in 2021, with a further 5m patients still requiring treatment due to the COVID-19 backlog. This level of activity, encompassing procedures such as tumour resection, reconstructive surgery, orthopaedics, assisted fertilisation, thrombectomy, and cardiovascular interventions, accounts for a staggering 10% of the healthcare budget, yet it is not always curative. Unfortunately, one third of all country-wide deaths occur within 90 days of surgery. The Department of Health and Social Care urges for "innovation and new technology", echoing the NHS Long Term Plan on digital transformation and personalised care. Our proposed CDT will contribute to this mission and deliver mission-inspired training in the EPSRC's Research Priority "Transforming Health and Healthcare". In addition to patient impact, engineering innovation in surgery and intervention has substantial economic potential. The UK is a leader in the development of such technology and the 3rd biggest contributor to Europe's c.150bn euros MedTech market (2021). The market's growth rate is substantial, e.g., an 11.4% (2021 - 2026) compound annual growth rate is predicted just for the submarket of interventional robotics. The engineering scientists required to enhance the UK's societal, scientific, and economic capacity must be expert researchers with the skills to create innovative solutions to surgical challenges, by carrying out research, for example, on micro-surgical robots for tumour resection, AI-assisted surgical training, novel materials and theranostic agents for "surgery without the knife", and predictive computational models to develop patient-specific surgical procedures. Crucially, they should be comfortable and effective in crossing disciplines while being deeply engaged with surgical teams to co-create technology solutions. They should understand the pathway from bench-to-bedside and possess an entrepreneurial mindset to bring their innovations to the market. Such researchers are currently scarce, making their training a key contributor to the success of the UK Government's "Build Back Better - our plan for growth" and UKRI's "five-year strategy". The cross-discipline collaboration of King's School of Biomedical Engineering & Imaging Sciences (BMEIS, host), Department of Engineering, and King's Health Partners (KHP), our Academic Health Science Centre, will create an engineering focused CDT that embeds students within three acute NHS Trusts. Our CDT brings together 50+ world-class supervisors whose grant portfolio (c.£150m) underpins the full spectrum of the CDT's activity, i.e., Smart Instruments & Active Implants, Surgical Data Science, and Patient-specific Modelling & Simulation. We will offer MRes/PhD training pathway (1+3), and direct PhD training pathway (0+4). All students, regardless of pathway, will benefit from continuous education modules which cover aspects of clinical translation and entrepreneurship (with King's Entrepreneurship Institute), as well as core value modules to foster a positive research culture. Our graduates will acquire an entrepreneurial mindset with skills in data science, fundamental AI, computational modelling, and surgical instrumentation and implants. Career paths will range from creating next generation medical innovators within academia and/or industry to MedTech start-up entrepreneurs.

Digital Health technologies can make a positive difference to the outcomes of patient treatment, management and care. Improving digital services and the sharing and use of data will also save time and resources so that staff can better focus on delivering medical and social care. Examples of such technologies include data collected through smartphones. For example, the ZOE COVID Symptom Study App used during the pandemic was jointly developed by King's College London, and now has more than four million users. Other digital technologies include wearable devices which can help monitor heart rate, activity and sleep and remotely assess and help manage a wide range of conditions. For example, the £23M Innovative Medicines Initiative RADAR-CNS led by King's has pioneered their use in depression, multiple sclerosis and epilepsy. Our aim is to enable the development of new digital technologies and reduce the time it takes for these to benefit patient care. The King's Health Partner (KHP) Digital Health Hub will do this by helping researchers, health and social care staff, patients and industry to work together better. We also hope to increase the availability of such technologies nationally by offering support to enable new businesses to grow rapidly, thereby making a more immediate difference to patients' lives. Digital health technologies have lots of potential but their widespread use is limited by: - A lack of examples of how clinicians, academics, engineers, quality assurance experts, health economists, patients and end users can best work together during development - Specific gaps in training and knowledge amongst the different groups, for example: - Academic and industry technologists may have trouble understanding NHS systems and fail to engage with the end users of the technologies they are trying to develop, such as health care providers, patients and carers. They may not know about or understand the complex regulatory pathway which needs to be followed before such technologies can be used in clinical practice. - Clinical specialists may lack the appropriate technical skills such as data analyses, coding and programming languages to help them develop digital applications they think will be helpful to their patients. The KHP Digital Health Hub will help to overcome the barriers to the rapid development and use of digital technologies nationally. It will be an accessible "ecosystem" comprising specialists from different sectors working together to improve understanding and use of digital technologies and addressing the government's long-term goals for health and social care. With our partners, we will connect the digital health research community to the substantial opportunities for investment in London and our diverse and world leading healthcare research environment. We have brought together a wealth of expertise from across KHP, including King's College London and partner NHS Trusts, patients and industry collaborators, to provide support and training, and create opportunities for the acceleration of digital health across the UK. KHP includes seven mental health and physical healthcare hospitals and many community sites with ~4.8 million patient contacts each year and a combined annual turnover of more than £3.7 billion. The KHP Digital Health Hub will provide: - proven expertise, infrastructure and experience of co-creation and commercialisation - a three-way clinical, academic and industry partnership - a physical location where technology developers can work collaboratively, and - an excellent track record in training which will be offered to all our partners across the health and social care sectors. With the right support and networks in place, digital health technologies have the power to transform patient care and experiences across the UK. The knowledge and expertise is all there, and together we can make sure it is shared, translated and built upon, at every step of the way.