title: Irreversible electroporation: a new ablation modality--clinical implications.
abstract: Irreversible electroporation (IRE) is a new tissue ablation technique in which micro to millisecond electrical pulses are delivered to undesirable tissue to produce cell necrosis through irreversible cell membrane permeabilization. IRE affects only the cell membrane and no other structure in the tissue. The goal of the study is to test our IRE tissue ablation methodology in the pig liver, provide first experience results on long term histopathology of IRE ablated tissue, and discuss the clinical implications of the findings. The study consists of: a) designing an IRE ablation protocol through a mathematical analysis of the electrical field during electroporation; b) using ultrasound to position the electroporation electrodes in the predetermined locations and subsequently to monitor the process; c) applying the predetermined electroporation pulses; d) performing histopathology on the treated samples for up to two weeks after the procedure; and e) correlating the mathematical analysis, ultrasound data, and histology. We observed that electroporation affects tissue in a way that can be imaged in real time with ultrasound, which should facilitate real time control of electroporation during clinical applications. We observed cell ablation to the margin of the treated lesion with several cells thickness resolution. There appears to be complete ablation to the margin of blood vessels without compromising the functionality of the blood vessels, which suggests that IRE is a promising method for treatment of tumors near blood vessels (a significant challenge with current ablation methods). Consistent with the mechanism of action of IRE on the cell membrane only, we show that the structure of bile ducts, blood vessels, and connective tissues remains intact with IRE. We report extremely rapid resolution of lesions, within two weeks, which is consistent with retention of vasculature. We also document tentative evidence for an immunological response to the ablated tissue. Last, we show that mathematical predictions with the Laplace equation can be used in treatment planning. The IRE tissue ablation technique, as characterized in this report, may become an important new tool in the surgeon armamentarium.
authors.affiliation: Center for Biomedical Engineering in the Service of Humanity and Society, School of Engineering and Computer Science, Hebrew University of Jerusalem, Givaat Ram Campus, Jerusalem, 91906 Israel. rubinksy@cs.huji.ac.il
authors.forename: Boris
authors.initials: B
authors.lastname: Rubinsky
authors.forename: Gary
authors.initials: G
authors.lastname: Onik
authors.forename: Paul
authors.initials: P
authors.lastname: Mikus
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000379:methods*; D018274:Electroporation / Q000379:methods*; D005260:Female; D008099:Liver / Q000166:cytology / Q000000981:diagnostic imaging / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D034421:Sus scrofa; D014463:Ultrasonography