Histotripsy is an innovative, non-invasive treatment that uses focused ultrasound waves to target and destroy tumor tissue, offering a promising alternative to traditional treatments like surgery or radiation. This procedure employs a robotic system to precisely direct ultrasound pulses at the tumor. The sound waves, lasting just microseconds, create microbubbles in the target tissue, which rapidly expand and collapse, causing mechanical disruption of the tumor cells. This process, known as cavitation, breaks down the cancer cells into liquid-like debris, effectively liquefying the tissue.
The technology was first introduced in 2003 and its pioneering paper was published in 2004, with the term “histotripsy” derived from the Greek words “histo” (soft tissue) and “tripsy” (breakdown). The focused ultrasound pulses generate cavitation from nanometer-sized gas pockets present in the tissue. When the pressure exceeds a certain threshold, these pockets expand and collapse, producing immense strain that fractures the tissue at a subcellular level, leaving behind a small margin of cellular injury. The treated tissue appears fragmented and homogenized, which can be visualized using diagnostic ultrasound imaging.
One of the key advantages of histotripsy is that it is a non-invasive procedure, meaning it does not require the use of needles, surgery, or radiation. Most patients can undergo the treatment and go home the same day, making it a less disruptive option for treating liver tumors and other cancers. The precision and minimal collateral damage of histotripsy make it an appealing option for patients with tumors that are difficult to treat with conventional methods.
How is it performed?
Histotripsy is performed under general anesthesia to ensure the patient remains still while the high-intensity ultrasound is directed at the tumor from outside the body. This non-invasive technique offers a relatively easy recovery, with most patients reporting minimal discomfort post-procedure. In a study, only about 22% of participants experienced some abdominal pain, which was typically alleviated with over-the-counter medications like Tylenol or Motrin.
One of the key advantages of histotripsy is its ability to avoid the usual delays associated with other treatments. Unlike surgeries or procedures that require a pause in chemotherapy for several weeks, histotripsy does not necessitate such interruptions. Additionally, since the procedure carries a negligible risk of bleeding, patients can continue their blood thinners without concern. The treatment can also be combined with other therapeutic approaches, such as surgery.
For patients with tumors on both sides of the liver, histotripsy can treat one side while surgical removal is performed on the other, allowing for comprehensive management of the disease. Moreover, histotripsy has been approved for “downstaging” liver tumors, effectively reducing their size to make patients eligible for liver transplantation, offering a new hope for individuals who may otherwise be ineligible for this procedure.
Who will Perform the Procedure?
It will be performed by Sekhar Padmanabhan, Kamran Idrees and Marcus Tan.
Sekhar Padmanabhan an assistant professor of Surgical Oncology and Endocrine Surgery at Vanderbilt University Medical Center, said on this occasion:
“What’s really exciting about histotripsy is that it allows for mechanical destruction of liver tumors with absolutely no incisions or needles – and no heat – causing minimal damage to surrounding tissue. Recovery time is minimal; patients typically leave the hospital the next day. As surgeons, we have a lot of different tools we can use to treat patients, but surgery is still indicated in many cases. And we will continue to offer thermal ablation techniques and minimally-invasive liver tumor surgery – we’re one of the few sites to offer that.”
Kamran Idrees, Division chief of Surgical Oncology and Endocrine Surgery at Vanderbilt University Medical Center, that also added:
“Besides being completely non-invasive, another key advantage of histotripsy is its ability to preserve important anatomical structures while destroying cancer cells. It affects the tumor cells, but it doesn’t affect the key structures within the liver such as blood vessels and the bile ducts. For any surgery and other procedures that we do, we stop chemotherapy for at least four to six weeks, and if they have a complication, there may be a delay in restarting the chemotherapy. With histotripsy, we don’t have to worry about any of that.”
Marcus Tan, Associate Professor of Surgery, Department of Surgical Oncology and Endocrine Surgery at Vanderbilt University Medical Center, will also perform the procedure.
About Vanderbilt University Medical Center
Vanderbilt University Medical Center (VUMC) is a leading healthcare institution in Nashville, Tennessee, known for its comprehensive range of services. With a workforce of 40,000 and over 3 million patient visits annually, VUMC operates multiple hospitals, clinics, and facilities throughout Middle Tennessee. The medical center maintains academic affiliations with Vanderbilt University, ensuring a strong connection between patient care, education, and medical research.
VUMC is recognized for its specialized care, operating the only Level 1 Trauma Center, Level 4 Neonatal Intensive Care Unit, and Level 3 Burn Unit in its region. Additionally, the LifeFlight helicopter ambulance service, staffed by Vanderbilt flight paramedics and nurses, is an essential part of the emergency care infrastructure, making over 2,800 flights each year. The medical center also has a strong track record in organ transplantation, having performed Tennessee’s first kidney transplant in 1962 and more than 3,000 kidney transplants since. VUMC has also achieved major milestones in liver, heart, lung, pancreas, and multi-organ transplants.
Vanderbilt-Ingram Cancer Center is a key component of VUMC, providing specialized cancer care for both adults and children. It is one of only 50 National Cancer Institute-designated cancer centers in the U.S. and the only one in Tennessee. As a member of the National Comprehensive Cancer Network, VUMC ensures that patients receive cutting-edge treatments while also contributing to cancer research and education. The medical center’s diverse services and its commitment to high-quality care make it a cornerstone of healthcare in the region.