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When local lesions require minimally invasive management, ablation is not limited to approaches based on heating or cooling. Irreversible electroporation devices, under imaging guidance (such as CT), enable the placement of electrode needles into the target area and deliver high-voltage electrical pulses to act on the cell membrane, thereby achieving non-thermal ablation.
The irreversible electroporation (IRE, commonly known as NanoKnife) system introduced by Jinshazhou Hospital of Guangzhou University of Chinese Medicine is applicable to the local treatment of various solid tumors. Through its non-thermal mechanism, intraoperative safety control, and conformal electrode placement, it provides an alternative minimally invasive option for lesions in complex locations.
1. Applicable to a wide range of solid tumors, providing minimally invasive options even for complex lesions
IRE is mainly used for local ablation of solid tumors such as liver cancer, pancreatic cancer, prostate cancer, and renal cancer, and its clinical value has been included in recommendations by guidelines such as NCCN, CSCO, and CACA. For patients requiring local control, those who are not suitable for conventional resection, or those who wish to minimize trauma, the NanoKnife system can be considered as one of the treatment options. In particular, for lesions adjacent to important structures such as blood vessels, bile ducts, the diaphragm, the gastrointestinal tract, or the hepatic hilum, the NanoKnife system demonstrates greater applicability and provides a new local treatment option for locations that are difficult to manage with conventional surgery or traditional thermal ablation.
2. Non-thermal mechanism allows lesion treatment while facilitating preservation of critical structures
The IRE system in our hospital does not rely on high or low temperatures to inactivate tissue; its core mechanism involves applying electrical pulses to the cell membrane to create irreversible pores and induce apoptosis. The advantage of this non-thermal effect lies in its relatively limited impact on important structures rich in connective tissue frameworks, such as blood vessels, bile ducts, ureters, and nerves, which also have a greater capacity for recovery after partial injury. For patients with lesions adjacent to critical structures, this means that while treating the lesion, there is a greater possibility of preserving surrounding normal tissues and functions.
3. Not affected by the heat-sink effect, balancing lesion ablation and protection of surrounding tissues
Traditional thermal ablation near large blood vessels is prone to insufficient ablation due to local perfusion carrying away heat, and it may also cause non-selective damage to structures such as blood vessels, nerves, the gallbladder, renal calyces, or the renal pelvis.
IRE does not rely on temperature changes to achieve ablation and is therefore not affected by the heat-sink effect, with clearer ablation boundaries. For lesions adjacent to important structures such as blood vessels, bile ducts, pancreatic ducts, or the hepatic hilum, the NanoKnife system is more conducive to balancing effective lesion treatment with preservation of surrounding tissues, which is one of the key reasons for its value in treating tumors in complex locations.
4. Conformal electrode placement and individualized settings enable more refined treatment
The NanoKnife system in our hospital supports multiple electrode configurations, including two-needle, three-needle, four-needle, six-needle, and vertically shifted five-needle arrangements, combined with individualized electrode settings to achieve conformal placement that closely matches the shape and extent of the lesion. For lesions with irregular morphology, complex boundaries, or proximity to critical structures, this design allows for more precise delineation of the treatment area.
At the same time, the trauma caused by electrode insertion mainly consists of several puncture sites of approximately 1 mm, resulting in minimal wounds and relatively limited additional damage to surrounding tissues. This reduces the postoperative recovery burden and improves both wound management and cosmetic acceptability, making "minimally invasive" a tangible treatment experience rather than merely a concept.
5. More refined intraoperative control for safer treatment delivery
The NanoKnife system in our hospital can actively monitor abnormal high current; if an abnormal current of 45A occurs intraoperatively, the system will automatically cut off output and provide an alert. It can also be integrated with an electrocardiographic monitoring system to deliver pulses at more appropriate timing. These features ultimately serve patient safety, as more controlled pulse delivery helps reduce the risk of arrhythmia and enhances intraoperative protection.
6. Combined CT and ultrasound guidance for more intuitive intraoperative assessment
Common approaches for IRE include percutaneous, laparoscopic, and open procedures, with image-guided percutaneous treatment being the most widely used. CT offers high spatial resolution, allowing clearer visualization of lesions, adjacent structures, and electrode positions, and contrast-enhanced CT can further delineate lesion boundaries. Immediate intraoperative contrast-enhanced CT, compared with preoperative imaging, enables direct observation of tumor contour, density, and post-ablation changes, facilitating accurate assessment of the treatment extent and timely additional ablation when necessary. For patients, this translates into more precise treatment and reduces the likelihood of repeated supplementary procedures, thereby improving overall treatment efficiency.
7. Immune activation and integration with comprehensive treatment, making local ablation part of a broader strategy
While achieving local ablation, IRE can also promote the release of tumor antigens and activate the immune system, and it is more readily integrated with chemotherapy, radiotherapy, immunotherapy, and other treatment modalities. Therefore, the NanoKnife system is not only a local treatment method but can also be incorporated into an overall treatment plan. Jinshazhou Hospital of Guangzhou University of Chinese Medicine provides one-stop diagnostic and treatment services for international patients, coordinating examinations, evaluation, local ablation, subsequent treatment, and follow-up according to the patient's condition, ensuring smoother continuity across all stages, minimizing repeated referrals and interruptions in the treatment process, and facilitating long-term management.
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