The Invasive Ablation Paradox: An Advocacy Featuring Histotripsy and the Challenges of Modernisation in Ablation

Abstract

Histotripsy is a mechanical, ultrasound-based ablation technology that utilizes high-pressure pulses to induce acoustic cavitation, liquefying targeted tissue at a sub-cellular level. Similar to non-thermal irreversible electroporation (NTIRE), its clinical philosophy focuses on "scientific shocks" designed to preserve the underlying tissue scaffold and vital structures such as nerves and blood vessels. While marketed as non-invasive, the modality faces significant counterarguments due to its "invasive on principle" nature. Specifically, like NTIRE, the procedure often necessitates general anesthesia and muscle relaxants to prevent complications like muscle convulsions or cardiovascular stress, mirroring the high physiological burden of invasive surgery. Furthermore, the transition to non-invasive destruction removes the possibility of obtaining a physical surgical specimen, leaving clinicians without definitive pathological confirmation of margins or grading. This review evaluates the technical success of such modalities against the clinical and ethical trade-offs regarding their "invasive-on-principle" nature.

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