Recently, the Department of Ultrasound Medicine of Zhejiang Cancer Hospital successfully performed the world’s first local-anesthesia “Wknife” ablation of papillary thyroid microcarcinoma. This procedure was coordinated, arranged, and performed by the team of Professor Xu Dong of ultrasound-guided intervention at Zhejiang Cancer Hospital, and was successfully carried out in the ultrasound intervention operating room.
The patient treated in this case was a 58-year-old male. Preoperative ultrasound showed a hypoechoic nodule at the lower pole of the right thyroid lobe, approximately 7mm*9mm*6mm in size; ultrasound suggested a malignant tumor, and preoperative biopsy confirmed papillary thyroid microcarcinoma.
Taking into comprehensive consideration the patient’s desire for minimally invasive treatment as well as the disease condition and physical status, the ultrasound intervention team decided through collective consultation to adopt “Wknife” technology for thyroid cancer ablation, which has the unique advantage of not damaging important structures such as nerves and blood vessels.
The entire ablation procedure was performed under local anesthesia. Under real-time B-ultrasound guidance, Professor Xu used the “Wknife” to ablate the cancer lesion through a single needle;
The entire procedure lasted about 15 minutes, with the ablation pulse actually acting for only 3 minutes and 20 seconds. During the procedure, the patient remained awake throughout and was able to communicate and interact with the physician, with no obvious pain or discomfort. Immediate postoperative contrast-enhanced ultrasound observation showed that the ablation effect met expectations, and no definite injury was seen to adjacent important structures such as the trachea, nerves, and esophagus;
During and after the procedure, the patient’s vital signs were stable, with no complaints of pain or other discomfort. The patient was discharged after one night of observation.
At present, the patient has completed one-month and three-month postoperative follow-ups. Imaging data show obvious post-ablation changes in the lesion area. Imaging at 3 months postoperatively showed significant absorption and shrinkage of the ablation zone (a 68.97% reduction in volume compared with the ablation baseline). Contrast-enhanced MR at 3 months postoperatively showed no abnormal enhancement, indicating complete imaging ablation.
Thyroid cancer is a frequently occurring and common disease of the endocrine system. The incidence of papillary thyroid carcinoma (PTC) in China is rising year by year. Among these, PTCs with a diameter ≤10mm are called papillary thyroid microcarcinoma (PTMC), the subtype with the largest proportional increase among the PTC population, accounting for 50%~60% of PTC cases. Thyroid surgery is an important means of treating malignant thyroid tumors, but because surgery readily causes complications and tends to leave scars, many patients prefer to choose thermal ablation techniques for treatment. If thermal ablation is not performed properly, it often causes thermal injury to surrounding important structures, such as burns to the recurrent laryngeal nerve and superior laryngeal nerve; therefore, when ablating thyroid nodules, physicians often need to perform hydrodissection (water isolation) beside the nodule to prevent thermal side injury. In addition, because most patients are left with a carbonized nodule after thermal ablation of thyroid nodules, this causes discomfort and worry.
The “Wknife” is the latest generation of irreversible electroporation (IRE) non-thermal selective physical ablation technology. During ablation, it destroys only the cellular structures within the ablation zone, while protecting important structures within the ablation range such as the extracellular matrix, blood vessels, nerves, trachea, and esophagus.
Because the Wknife has non-thermal characteristics and does not cause thermal injury to the ablation zone or surrounding tissues, it does not require hydrodissection as thermal ablation techniques do to prevent injury; after Wknife ablation, the lesion area can be naturally absorbed by the body and will not, as with other thermal ablation techniques, leave a carbonized nodule that is difficult to resolve and causes patient anxiety. It can be seen that Wknife ablation of thyroid lesion tissue breaks through the limitations and shortcomings of traditional ablation methods, achieving truly minimally invasive, painless, lesion-eliminating, and function-preserving treatment, and is expected to become a new treatment option for thyroid lesions.
On the other hand, in this procedure, with the support of the Wknife and the newly developed single-needle ablation technology, Professor Xu Dong’s medical team innovatively solved the difficult problems of traditional IRE devices requiring “tracheal general anesthesia (combined with a sufficient amount of muscle relaxant)” and multiple parallel needle placement, realizing a truly new IRE procedure of “local anesthesia” plus “single-needle” ablation. This greatly reduced the difficulty of the surgical operation, shortened the overall treatment time, made IRE ablation procedures more efficient, safe, and convenient, and also maximized patient benefit.
The successful performance of this procedure is a perfect embodiment of the “needle instead of scalpel, no trace after ablation” treatment philosophy of the ultrasound intervention team at Zhejiang Cancer Hospital. It also preliminarily indicates that the “Wknife” is a safer and more efficient new method for thyroid lesion ablation; it marks that the ultrasound intervention team at Zhejiang Cancer Hospital, in the field of thyroid tumors, now possesses a non-thermal and powerful local treatment modality following thermal ablation, and it also marks a brand-new breakthrough for IRE in China in the treatment of papillary thyroid microcarcinoma.
The “Wknife” technology is the latest-generation R&D achievement from more than 20 years of research and development by the team of Professor Yao Chenguo at Chongqing University, and was commercialized by Hangzhou winonco Medical Technology Co., Ltd. (www.wknife.cn).
Since 2000, Professor Yao Chenguo has been dedicated to research on tumor cell electroporation. In 2004, he published the first international academic research paper in this field. Since then, Professor Yao Chenguo’s team has continuously developed several generations of products and formed unique independent intellectual property rights. He is internationally recognized as a pioneer and leader in electroporation tissue ablation technology, and has established China’s core intellectual property rights in irreversible electroporation.
Copyright © Hangzhou Winonco Medical Technology Co., Ltd. All Rights Reserved. Web design
