ENNanoKnife is the brand name of a device for irreversible electroporation (IRE), a method that destroys a tumour with short electrical pulses rather than a scalpel or heat; in Germany it is used only at some centres and only for selected patients. A patient who has been told that a tumour of the pancreas or liver lies too close to large blood vessels to operate may hear about it, and so may a man with prostate cancer looking for a gentler option.
This page covers how IRE works, where it is considered, what the evidence shows, who may be suitable and how an assessment for NanoKnife in Germany is arranged. Whether it suits a particular person is decided by doctors after reviewing the scans and reports; nobody can promise a result in advance.
How irreversible electroporation works
IRE destroys a tumour with electrical pulses that damage its cell membranes. Several needle electrodes are placed around the tumour under CT or ultrasound guidance, and very short high-voltage pulses are passed between them. These create permanent pores in the membranes of the tumour cells, and the cells die.
Unlike heat-based methods such as radiofrequency ablation, IRE does not rely on heating, so the framework of nearby blood vessels and bile ducts is largely spared — which is why it is discussed for tumours next to such structures. It is done under general anaesthesia with full muscle relaxation, as the pulses would otherwise make the muscles contract strongly, and the pulses are synchronised with the heartbeat (ECG) to avoid heart rhythm disturbances.
Where NanoKnife is considered: pancreas, liver, prostate
NanoKnife is considered for tumours of the pancreas, liver and prostate, each time only in a specific situation. In pancreatic cancer, this is a locally advanced tumour that has grown around large blood vessels without spreading to distant organs and remains inoperable after chemotherapy. The overall approach is covered on the page on pancreatic cancer treatment.
For liver tumours and metastases, IRE is considered when a lesion lies at the liver hilum, where the main vessels enter the liver and the bile ducts leave it, or next to large vessels, and neither surgery nor thermal ablation is possible. Other options are covered on the page on liver metastases treatment.
In prostate cancer, IRE is discussed as a focal therapy that treats only the part of the gland containing the tumour. The main options are described on the page on prostate cancer treatment. Another focal method is HIFU therapy, in which focused ultrasound destroys the tissue with heat rather than with electrical pulses.
What the evidence says
The evidence is still limited: most published data come from small or observational studies, and large randomised trials comparing IRE with standard treatment are few. The current German S3 clinical guideline on pancreatic cancer (S3-Leitlinie Exokrines Pankreaskarzinom, 2024 version) does not mention IRE or other local ablative methods; for a locally advanced tumour, it recommends starting with chemotherapy.
In prostate cancer, focal therapies are also not standard care and are mainly offered within studies or registries. The German S3 guideline on prostate cancer lists surgery, external beam radiotherapy and brachytherapy as the standard treatments. A recent systematic review of IRE in prostate cancer concludes that comparative studies are needed to define its place among the other options. In short, IRE is an option for selected patients after a tumour board decision, not a replacement for proven treatment.
Who may be suitable and what the procedure involves
IRE may be suitable when the tumour is of limited size, there are no distant metastases and the person’s general fitness allows anaesthesia. Reasons against it include certain heart rhythm disorders, some implanted devices such as a pacemaker, and metal near the treatment area; the final list is set by the treating centre.
After the procedure, patients usually stay in hospital for a few days. Possible complications depend on the organ — for example inflammation of the pancreas, bleeding or heart rhythm disturbances. The result is checked with follow-up imaging and cannot be predicted in advance.
Frequently asked questions
Is NanoKnife the same as irreversible electroporation?
In practice, yes: NanoKnife is the brand name of a device, and the treatment it delivers is irreversible electroporation. Doctors and studies refer to the method, not the device, so in medical records look for the abbreviation IRE or the German term irreversible Elektroporation.
Can NanoKnife replace surgery or chemotherapy?
No. IRE is an option for selected patients, not a replacement for proven treatment. In pancreatic cancer it is discussed when the tumour remains inoperable after chemotherapy, and for liver tumours when neither surgery nor thermal ablation is possible. If proven treatment is feasible, it comes first, and the tumour board decides whether IRE has a place in the plan.
Is NanoKnife treatment painful?
During the procedure the patient feels nothing, as it is carried out under general anaesthesia with full muscle relaxation. Afterwards, patients stay in hospital for a few days while doctors monitor them for complications, which depend on the organ treated. What to expect in your own case is best discussed with the centre beforehand.
How much does NanoKnife treatment cost in Germany?
There is no single price: the cost is given only by the hospital, in a written estimate (Kostenvoranschlag) prepared after reviewing the documents. It covers tests, the procedure and the hospital stay, so the amount depends on the organ and the extent of treatment. Costs are worth discussing once doctors confirm that IRE is suitable at all.
How AlenMed arranges an assessment for NanoKnife treatment
The assessment starts with documents: recent CT or MRI discs (the image files, not just the reports), the histology report on the tumour tissue and records of any chemotherapy or radiotherapy. AlenMed has them translated for the tumour board of a partner hospital, where specialists weigh IRE against surgery, radiotherapy and drug therapy — in effect, a second opinion in Germany.
IRE is performed only at a limited number of centres and not by every interventional radiology department (treatment through needles and catheters under imaging), so AlenMed asks partner hospitals directly whether they offer it for the specific organ and case. The cost is set only in the hospital’s estimate (Kostenvoranschlag). AlenMed’s office is in Munich, with partner hospitals across Germany; AlenMed also helps with the visa invitation and arranges an interpreter.
This material is for reference only and is not an offer. Whether IRE is appropriate in your case is decided by the treating doctors after an examination in person.
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