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Irreversible electroporation (NanoKnife), explained | CION Cancer Clinics
Irreversible electroporation, often called NanoKnife, kills tumour cells with short, strong electrical pulses sent between needles placed around the tumour. Because it works mainly without heat, nearby blood vessels and ducts can often survive. It is used for some pancreas, liver and prostate tumours that heat would put at risk. Evidence is still limited, very few centres in India offer it, and it needs a full general anaesthetic. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is irreversible electroporation, or NanoKnife?
- Which cancers is IRE used for?
- What happens during an IRE procedure?
- What do families often misunderstand about NanoKnife?
- Who does IRE not suit, and how do you find it in India?
- What do the terms around IRE mean?
- Common questions about irreversible electroporation
The short answer
What is irreversible electroporation, or NanoKnife?
Irreversible electroporation, often called IRE or by the machine name NanoKnife, kills tumour cells with very short, strong electrical pulses sent between needles placed around the tumour. It works mainly without heat, so it is used for tumours sitting against blood vessels or ducts that heat would damage.
How the pulses kill cells
The pulses punch tiny holes in the wall of each cell. If the pulses are strong enough, the holes do not close, and the cell dies over the following days. The body then clears the dead tissue slowly.
Why it spares some structures
Blood vessels and bile ducts are held together by a tough framework of fibres rather than by living cells alone. That framework survives the pulses, so the vessel or duct can often heal. This is the main reason IRE exists. Heat and cold do not make that distinction.
How settled the evidence is
IRE is newer than heat ablation. Studies so far are mostly small and from a limited number of experienced centres. Guidance bodies such as NICE have advised that it be used with special arrangements or in research.
Who carries it out
Usually an interventional radiologist working closely with a surgeon and an anaesthetist. For pancreas tumours it is sometimes done during an open operation. Because the procedure is uncommon, the team's own experience matters more than the name of the machine.
Where it has been studied
Which cancers is IRE used for?
IRE is usually considered only when the tumour's position rules out heat, cold or an operation.
Pancreas
Tumours wrapped around major blood vessels that cannot be removed, often after chemotherapy has kept them from spreading. This is the most discussed use, and results are still being studied.
Liver
Small tumours lying beside large vessels or main bile ducts, where heat could cause a leak or narrowing.
Prostate
Studied as a way to treat only part of the prostate, aiming to protect the nerves and muscles involved in erections and bladder control.
Kidney and others
Small numbers of kidney and other tumours near delicate structures, mainly within research studies.
Using IRE outside these settings is rare.Not sure whether this applies to you?
Ask an oncologistWhat is involved
What happens during an IRE procedure?
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Heart and fitness checks
An ECG, a recording of the heart's rhythm, is usual, because the pulses are timed to the heartbeat. Blood tests and a recent scan are needed. A pacemaker or some heart rhythm problems can rule IRE out.
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General anaesthetic
IRE is always done under general anaesthesia with a medicine that relaxes the muscles fully. Without it, the pulses would make the muscles jerk strongly.
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Placing the needles
Several needles are placed around the tumour, through the skin under CT or ultrasound guidance, or during an open operation. The spacing between them is measured carefully.
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Delivering the pulses
The machine sends the pulses in short bursts linked to the heartbeat. The team watches the heart rhythm and the scan throughout.
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Recovery and scans
Many people stay in hospital for a short time. Pancreas treatment often means a longer stay. Check scans follow, and the treated area can look confusing on early scans.
Commonly believed
What do families often misunderstand about NanoKnife?
"NanoKnife is a knife or a tiny robot."
It is neither. NanoKnife is a brand name for an IRE machine. Nothing cuts. The name refers to the tiny holes the pulses make in cell walls.
"It works for tumours that no one else can treat."
IRE can reach some tumours near vessels that heat cannot. It does not help cancer that has spread widely, and for pancreas cancer it is still an area of research, not an established answer.
"Because there is no heat, there are no risks."
IRE carries real risks, including bleeding, leaks from the pancreas or bile ducts, and heart rhythm problems during the pulses. How likely each is depends on the organ, so ask your team about your case.
"We should go abroad because it is not done in India."
A few centres in India have used IRE. Before travelling anywhere, ask any centre how many procedures it has done for your organ, and what it would offer if IRE does not suit you.
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Being straight with you
Who does IRE not suit, and how do you find it in India?
IRE does not suit cancer that has spread to other organs, large tumours, or people who cannot safely have a general anaesthetic. It may not suit someone with a pacemaker, certain heart rhythm problems, or metal stents near the tumour.
Finding a centre
The machine is expensive and not widely available. Very few centres in India offer it, and experience matters a great deal. This page does not claim that any particular centre, including CION, offers IRE. Ask any centre directly whether it has the machine, how many cases it has treated for your organ, and whether a surgeon and an interventional radiologist decide together.
What this page cannot tell you
It cannot say whether IRE is right for you, or what it would achieve for your tumour. It cannot give you a cost, because packages differ a lot. Your treating team weighs your scans, biopsy and health, and can tell you what the other choices are.
Questions worth asking
Why IRE rather than surgery, radiotherapy, chemotherapy alone or heat ablation? What is the aim, easing symptoms or controlling the tumour? What happens if the check scan shows tumour left? Bring a family member to note the answers.
A second opinion before an uncommon procedure is reasonable, and good teams expect you to ask for one.Words you may hear
What do the terms around IRE mean?
- Locally advanced
- A cancer that has grown into nearby vessels or tissue but has not spread to distant organs.
- Unresectable
- The team does not think the tumour can be safely removed by an operation.
- ECG-synchronised
- Pulses timed to the heartbeat, so they do not disturb its rhythm.
- Neuromuscular blockade
- A medicine given during anaesthesia that stops the muscles moving while the pulses are delivered.
- Ablation zone
- The area treated. After IRE it can look swollen or unclear on early scans, which is not always a sign of tumour.
Did you know
The same idea of opening holes in cell walls with electrical pulses is used, at much gentler strength, in laboratories to get medicines and genes into cells. IRE simply turns it up until the holes do not close.
Questions we are asked
Common questions about irreversible electroporation
Is NanoKnife available in India?
A small number of centres in India have used it, but it is not widely available. Availability changes over time, so ask directly. Before agreeing, ask how many procedures the team has done for your organ, and what other options they considered for you.
Can IRE treat pancreatic cancer?
It has been used for pancreatic cancer that cannot be removed because it surrounds major vessels, usually after chemotherapy. The studies are mostly small, and it is not yet a standard treatment. Guidance such as NICE's advises special arrangements or research use. Ask your team where it fits for you.
Is IRE better than radiofrequency or microwave ablation?
Not in general. Heat ablation is better studied and simpler for most small tumours. IRE is considered mainly when a tumour sits against a vessel or duct that heat would harm. The choice depends on where the tumour is, not on which method is newest.
Why does IRE need a full anaesthetic?
The electrical pulses would make your muscles jerk strongly. So you are fully asleep and given a medicine that relaxes the muscles completely, with a breathing tube. Sedation alone is not enough. This is one reason people who cannot safely have a general anaesthetic are not suitable.
What are the risks of IRE?
Risks include bleeding, heart rhythm changes during the pulses, and, for pancreas and liver, leaks or inflammation around the treated area. Pancreas treatment carries more risk than treating a small liver tumour. Ask your team how likely each risk is in your case.
Will I need chemotherapy as well?
For pancreas cancer, IRE is usually given alongside chemotherapy rather than instead of it, because the cancer can be present elsewhere in tiny amounts. For other organs it depends on the cancer. Your oncologist will explain the full plan before you agree to IRE.
Can I have IRE if I have a pacemaker or a stent?
A pacemaker or some heart rhythm problems may rule it out, and metal close to the tumour, such as some bile duct stents, can change how the pulses spread. Tell the team about every device and implant early. They will decide whether IRE is still possible.
Is IRE covered by Aarogyasri or insurance?
Cover for newer procedures varies a lot. Aarogyasri, CGHS, ECHS, EHS and cashless insurance may not include IRE in their standard packages, and the needles are a large separate cost. Ask the centre for a written estimate and check it against your card or policy before a date is fixed.
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Sources
- NICE — Irreversible electroporation for treating pancreatic cancer (IPG579)
- Cancer Research UK — Pancreatic cancer treatment
- National Cancer Institute — Types of Cancer Treatment
- American Cancer Society — Tumor Ablation for Liver Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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