3 The procedure
3.1 The aim of irreversible electroporation (IRE) is to destroy cancerous cells using a series of short electrical pulses using high-voltage direct current. This creates multiple holes in the cell membrane, irreversibly damaging the cells' homeostatic mechanisms and leading to cell death.
3.2 In pancreatic cancer, IRE is usually done to increase survival in people with locally advanced disease, or to treat resection margins to increase the success of curative surgical resection.
3.3 The procedure is done with the patient under general anaesthesia. A neuromuscular blocking agent is essential to prevent uncontrolled severe muscle contractions caused by the electric current. Several electrode needles (typically 3 to 5) are introduced percutaneously (or by open surgical or laparoscopic approaches), and inserted in and adjacent to the tumour using image guidance. A series of very short electrical pulses is delivered over several minutes to destroy the tumour. The electrodes may be repositioned under imaging guidance to extend the zone of electroporation until the entire tumour and an appropriate margin have been destroyed.
3.4 To minimise the risk of arrhythmia, cardiac synchronisation is used to time delivery of the electrical pulse within the refractory period of the heart cycle.