Interventional oncology · London
NanoKnife (IRE) - private in London.
Non-thermal tumour ablation for pancreatic, prostate and liver disease sitting next to vessels, bile ducts or nerves - where heat-based ablation is unsafe and surgery is off the table. MDT-reviewed, in named London centres.
IRE
Non-thermal · MDT-led
Overnight stay. Back at desk in 3 to 7 days.
What it is
Killing tumour cells with electricity, not heat.
NanoKnife is the trade name for irreversible electroporation, or IRE. It is a non-thermal method of ablating tumours using very short, very high-voltage electrical pulses.
How it works
Paired needle electrodes are placed around the tumour under image guidance. A generator delivers a series of 90 to 100 microsecond pulses at 1,500 to 3,000 volts between them. The pulses open permanent nanopores in the tumour cell membranes; the cells cannot maintain their ionic balance and die by apoptosis. No heat is generated to any clinically significant degree.
Why it matters
Because IRE does not rely on heat, it spares the connective-tissue framework of the treated volume. Blood vessels, bile ducts, ureters and nerves running through the ablation zone remain patent and functional. That is what makes it usable for pancreatic tumours wrapped around the coeliac axis, liver lesions kissing the portal vein, and prostate disease sitting on the neurovascular bundle.
Indications
Where IRE is the right technique.
A short, deliberately narrow list. IRE is not first-line for anything, but it is the answer for a specific set of "difficult location" problems.
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Locally advanced pancreatic cancer (LAPC)
Unresectable stage III tumours encasing the coeliac axis, SMA or portal vein - where surgery and thermal ablation are both off the table.
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Focal prostate cancer
MRI-visible unilateral disease, Gleason 3+4, as an alternative to whole-gland surgery or radiotherapy in carefully selected men.
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Liver metastases and HCC near vessels
Lesions abutting portal veins, hepatic veins or bile ducts where microwave or RFA would cause thermal injury or fail through heat-sink.
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Kidney tumours near the collecting system
Central renal tumours where cryoablation or RFA risks urothelial injury.
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Soft-tissue tumours near major nerves
Retroperitoneal or pelvic disease abutting nerve roots that must be preserved.
Focal prostate IRE
An alternative to whole-gland treatment, in the right man.
Focal IRE targets only the MRI-visible index lesion, sparing the rest of the gland, the neurovascular bundle and the urethral sphincter.
Who it suits
Men with a single MRI-visible unilateral lesion, Gleason 3+4 (ISUP 2), PSA under 15 ng/mL, and a life expectancy that makes treatment worthwhile.
The upside
Continence and erectile function preserved in 85 to 90% of men at 12 months. Same-week discharge. Salvage prostatectomy or radiotherapy remains possible if needed.
The caveat
The concern with any focal approach is undertreatment - missed satellite disease elsewhere in the gland. That is why MRI, template biopsy and MDT selection matter more than the ablation itself.
The procedure
What actually happens in theatre.
IRE is not a light-sedation procedure. The high-voltage pulses would cause whole-body muscle contractions if you were not fully relaxed, and a general anaesthetic with paralysis and ECG gating is mandatory.
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01
General anaesthetic with full muscle relaxation
Required to prevent the strong muscle contractions the high-voltage pulses would otherwise cause across the whole body.
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02
ECG-gated pulse delivery
Every pulse is synchronised to the refractory period of the cardiac cycle, so the current cannot trigger an arrhythmia.
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03
Two to six needle electrodes, image-guided
Placed under CT or ultrasound guidance and triangulated around the tumour to a sub-millimetre spacing tolerance.
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90 to 100 microsecond pulses, 1,500 to 3,000 volts
A short burst of high-voltage pulses opens permanent pores in the cell membrane. The cell dies by apoptosis, not by heat.
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05
Total theatre time 90 to 120 minutes
Overnight stay for observation. Most patients are eating and mobile the next morning.
Indicative cost
Private NanoKnife pricing in London.
All-inclusive package figures across our London centres. Send the imaging and we come back with firm quotes.
| Package | Indicative range | Includes |
|---|---|---|
| Oncology IRE (pancreas, liver, kidney), single session | £12,000 to £22,000 | MDT, anaesthetic, theatre, overnight stay, first follow-up scan |
| Focal prostate IRE package | £14,000 to £24,000 | mpMRI, template biopsy review, anaesthetic, theatre, follow-up PSA schedule |
Insurance funding is inconsistent and usually settled on a case-by-case basis. Bupa, AXA Health and Vitality have all funded oncology IRE with the right MDT documentation. Focal prostate IRE is more commonly self-funded.
Where it is offered
London centres with an active IRE programme.
A small handful of teaching hospitals and private centres run IRE with the case volume to do it well.
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King's College Hospital Private
HPB unit, LAPC and liver programmes
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University College London Hospital (UCLH) Private
Focal prostate IRE, HPB
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HCA London Bridge Hospital
Interventional oncology, liver and pancreas
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The Royal Marsden Private Care
MDT-led IRE for select oncology cases
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The London Clinic
Interventional radiology and urology IRE
Outcomes
What the published data actually says.
Selected series from high-volume European and US centres. Numbers are meaningful, but selection bias is real - IRE is offered to a specific slice of patients.
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LAPC: median OS 24 to 30 months
In selected series combining IRE with FOLFIRINOX or gemcitabine/nab-paclitaxel, versus 12 to 15 months with chemotherapy alone.
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Prostate focal IRE: PSA control 75 to 85% at 3 to 5 years
In-field failure is uncommon; out-of-field new disease is the more usual pattern and is often re-treatable.
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Continence and erectile function preserved in 85 to 90%
A meaningful advantage over robotic prostatectomy and whole-gland radiotherapy in men with pre-treatment potency.
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Repeatable
Because IRE spares the connective-tissue scaffold, the same site can be treated again if imaging shows residual disease.
Recovery
Home the next morning. Back at your desk within a week.
IRE recovers far faster than surgery, and slightly slower than thermal ablation because of the GA and muscle relaxation.
Day 0
Procedure, overnight observation on the ward.
Days 1 to 5
Home. Mild soreness at needle sites, controlled with paracetamol.
Days 3 to 7
Back to desk-based work. Light walking encouraged.
Week 4 to 6
First follow-up MRI or CT. Gym and driving usually resumed by now.
How it compares
IRE versus heat ablation, cryo, SBRT and surgery.
IRE is not "better" than any of these. It is different, and it is the right tool for a specific location problem.
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Radiofrequency and microwave ablation
Both work by heat. Contraindicated within 5 mm of a large vessel (heat-sink cools the tumour edge) or a bile duct or nerve (thermal injury). IRE is the answer when heat is unsafe.
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Cryoablation
Cold-based ablation, safer near collecting systems than heat but still causes collateral damage to nerves and vessels. IRE is preferred for pancreas and periductal liver work.
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SBRT and CyberKnife
Non-invasive stereotactic radiotherapy is a genuine alternative for LAPC, prostate and liver disease. Choice depends on tumour location, prior radiation and whether tissue is needed for genomic testing.
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Surgery
Whole-gland prostatectomy or Whipple resection remains standard of care when technically feasible. IRE is offered when surgery is refused, contraindicated, or would carry unacceptable functional cost.
Related
Alternatives and neighbouring treatments.
FAQs
The questions we hear most.
Written for patients and referring GPs. If yours is not here, ask us on the enquiry form.
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Is NanoKnife done as a day case?
No. IRE requires a general anaesthetic with full muscle relaxation and ECG gating, so an overnight stay for observation is standard. Most people go home the following morning and are back at desk-based work within 3 to 7 days.
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Can NanoKnife be repeated if the tumour comes back?
Yes. Unlike surgery or radiotherapy, IRE preserves the connective-tissue scaffold, so the same anatomical site can be treated again. This is one of the reasons it is considered for locally advanced pancreatic cancer and for focal prostate disease where surveillance may pick up residual or new in-field disease.
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Does private medical insurance cover NanoKnife?
Coverage is inconsistent. Bupa, AXA Health and Vitality will sometimes fund IRE for oncology indications on an individual case-review basis, particularly for LAPC where standard options are exhausted. Focal prostate IRE is more often self-funded. We help you prepare the pre-authorisation pack and MDT summary.
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Will erectile function and continence be preserved after focal prostate IRE?
In published series from UCLH and other high-volume European centres, 85 to 90% of men retain pre-treatment continence and erectile function at 12 months. This is a genuine advantage over robotic prostatectomy and whole-gland radiotherapy, and the main reason many men choose focal therapy.
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Is the case reviewed by a multidisciplinary team first?
Yes. Every NanoKnife case in our network is discussed at a specialist MDT - HPB, urology or interventional oncology - with a surgeon, oncologist, radiologist and pathologist present. IRE is only offered when the MDT agrees it is the right technique for the tumour and the patient.
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What does recovery look like week by week?
Overnight stay, then home the next morning. Mild soreness at the needle sites for 3 to 5 days. Back to desk work in 3 to 7 days. Back to gym and driving in 2 weeks. First follow-up MRI or CT at 4 to 6 weeks, then at 3 months, 6 months and annually.
Talk to us
Send us the imaging. We come back within one working day.
A specialist MDT read on whether NanoKnife fits your case, which London centre is the right introduction, and what the all-in cost looks like. Free, and independent.