Irreversible electroporation or IRE is a novel technology that is now commercially available with the name Nanoknife. It is non-thermal ablative technique that uses high-voltage, low-energy D/C current to cause cell death. The electrical energy creates multiple pores in a cell membrane and disrupts the homeostasis mechanism across the cell organelles inducing cell death. Since the techique is not based on thermal effects, heat-sink from adjacent vessels is not relevant.
IRE is administered under general anesthesia with administration of a neuromuscular blocking agent to prevent undesirable muscle contraction and by using cardiac gating to synchronize pulse delivery with absolute refractory period to prevent cardiac arrhythmias.
IRE preserves structural integrity of bile ducts and vessels and enables safe treatment of tumors adjacent to vital structures. In addition, IRE has expanded the potential clinical applications of thermal-based ablation techniques, allowing the treatment of organs such as the pancreas where other ablative techniques are not applicable given the high risk of damage of critical structures located in its proximity.