01 /2013 - Klinik für Viszeral

surg.ch
Improving Care through Innovation – Nanoknife at USZ
Michelle De Oliveira, michelle.deoliveira@usz.ch
The University Hospital of Zurich is continuously
implementing new advanced
technologies for better patient care. The
newest Nanoknife system cancer treatment
is offered for patients in Switzerland
by the Swiss HPB Center together
with the Interventional Radiology team.
The Nanoknife system utilizes irreversible
electroporation (IRE). This is a novel
technology implying a series of rapid
electrical pulses. Those pulses trigger
opening of cell membranes in cancer. The
application of an electric fi eld across a
cell alters the trans-membrane potential.
Thus, the lipid bilayer structure is disrupted
and small nanopores are created in
the cell membrane allowing uncontrolled
transport of micro- and macromolecules.
These pores become permanent with the
high voltage and contribute to cell death
by interfering with cell homeostasis.
By using the NanoKnife system, our multidisciplinary
team insert two or more
needlelike probes into the cancerous tumor
area by image-guided. Then probes
rapidly deliver very short electrical
pulses that target the tumor.
An ideal candidate for IRE treatment
should have a tumor located within a
specifi c organ without systemic metastases.
In terms of contraindications, it
should not be applied to patients with
pacemakers or patients who have a history
of cardiac arrhythmias.
The great advantage of such a system
is the greatly enhanced protection of
tissue, particularly nerves, vessels, bile
ducts, which was not possible with all
previous ablation systems such radiofrequency
(RFA) or microwave ablation.
Additionally, the Soft Tissue Ablation
Registry has been created among the
centers that are currently using this technology
in the United States,
The University of Louisville in Kentucky
is the primary investigator for the registry.
Our Swiss HPB center is collaborating
for scientifi c evaluation of the Nanoknife
system in the treatment of liver, bile
and pancreatic cancers.
Fig. 1. Liver Tumor (CRLM) treated by IRE system
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