Facing this “tricky” situation, Professor Liao Zhengyin chose the Wknife developed by Hangzhou winonco. This product uses non-thermal ablation technology and requires neither general anesthesia nor muscle relaxants, allowing the procedure to be completed under local anesthesia alone, which precisely matched the extremely limited treatment options available to this patient.

This procedure was performed under CT guidance. After determining the target area, Professor Liao Zhengyin used only one bipolar ablation needle under local anesthesia, precisely puncturing into the target lesion area for ablation; during the entire pulse delivery, the patient had no muscle contraction, had stable vital signs, and remained conscious throughout. The whole procedure took less than one hour; intraoperative imaging showed that the ablation zone completely covered the lesion, and the ablation effect was satisfactory and met expectations.

[Intraoperative]

For the operator, the “simplicity” of this procedure was particularly striking: no repeated calculations for parallel multi-needle placement, no cumbersome combination of muscle relaxant management — local anesthesia throughout, placing one bipolar needle, delivering pulses, and confirming ablation coverage on imaging — the operating procedure for ablation at a high-risk site was compressed to the shortest, and the whole procedure was completed in a short time. 

Professor Liao highly praised it: “With only a single bipolar needle, the domestically produced Wknife perfectly completed the ablation of a complex liver cancer at a special site under local anesthesia, with no muscle contraction throughout. Not only is the efficacy reliable, but it also greatly lowers the threshold of surgical operation. As the first irreversible electroporation ablation for liver cancer under local anesthesia in Southwest China, the ultimate operational convenience demonstrated by Wknife not only sets a new clinical benchmark, but also lays a solid foundation for the rapid popularization and promotion of this technology in Southwest China, and will certainly benefit more tumor patients.”

The academic community has long affirmed the advantages of irreversible electroporation (IRE) technology: non-thermal ablation, clear boundaries, preservation of vascular structures such as blood vessels and bile ducts, and a favorable immunostimulatory effect; its value for tumors at high-risk sites is beyond doubt — but it is not widely performed clinically, because the operation is too difficult.

Difficult needle placement: conventional IRE products such as NanoKnife require parallel arrangement of multiple electrode needles, with needle spacing and insertion depth demanding precision down to the millimeter; fewer than ten master-level experts in all of China can perform this procedure well;

Difficult anesthesia: the procedure must be completed under general anesthesia combined with deep muscle relaxation, and also requires ECG synchronization, which deters many departments and physicians; however good the efficacy, if no one can perform it and no department dares to, the technology can only remain in papers and a few centers;

Difficult for patients: patients must bear the risks brought by general anesthesia and multi-needle placement during surgery, and the treatment cost is relatively high.

And the recently approved and marketed product of winonco — Wknife — suppresses muscle contraction with wide-spectrum synergistic pulse technology and simplifies multi-needle placement into a bipolar single needle — one needle under local anesthesia can solve the problem, making a previously difficult procedure easy to master.

This procedure broke through the limitation that advanced liver cancer with extremely poor liver function is difficult to tolerate ablation, fully demonstrating the technical advantages of Wknife, and marking that irreversible electroporation tumor ablation has entered a new era of local anesthesia with a single needle.