NanoKnife (IRE)
How IRE is used and what to ask.
Read more →← Patient guides
Comparison
NanoKnife (IRE) vs microwave and radiofrequency ablation
Both treat a tumour through needles placed under imaging. They work in different ways, and the better choice depends on the tumour, its position and the evidence for that cancer.
The short version
Microwave (MWA) and radiofrequency (RFA) ablation use heat to destroy tissue. Irreversible electroporation (IRE, sold as NanoKnife) uses short electrical pulses to damage cell membranes without relying on heat.
Thermal ablation has a long track record for small liver tumours. IRE is newer, and its evidence is thinner. Neither suits every tumour, and a multidisciplinary team should choose.
Side by side
| IRE (NanoKnife) | Microwave / radiofrequency ablation | |
|---|---|---|
| How it works | Electrical pulses open cell membranes and cause cell death | Heat from probes destroys tissue |
| Heat involved | No, mainly non-thermal | Yes |
| Anaesthesia | General anaesthesia and muscle relaxation, with heart rhythm monitoring | Local, sedation or general, depending on the site |
| Near vessels and ducts | Sometimes considered when heat is risky | Cooling by nearby blood flow can leave tumour untreated; heat can injure ducts |
| Best-studied use | Limited. Mostly selected liver and pancreatic tumours | Small liver tumours, and also selected kidney and lung tumours |
| Evidence level | Limited. NICE says pancreatic use only in research | Larger body of evidence for small liver tumours |
| Typical size | Usually small tumours, with limits on size | Small tumours, often a few centimetres |
| Main risks | Bleeding, infection, pancreatitis, bile leaks, heart rhythm changes, clots | Bleeding, infection, burns to nearby organs, incomplete treatment, lung collapse in lung ablation |
| Recovery | Short hospital stay in most cases | Often short, sometimes same day |
When IRE is considered
Doctors sometimes consider IRE when a tumour is close to major vessels or bile ducts and heat could cause injury. Examples include selected pancreatic or liver tumours when surgery is not possible. NICE reviewed IRE for pancreatic cancer and advised that it should only be used in the context of research because evidence was limited in amount and quality.
IRE needs a general anaesthetic, and the pulses are timed with the heartbeat. Patients with certain heart problems may not be suitable.
When thermal ablation is considered
MWA and RFA are widely used for small liver tumours, and for selected kidney and lung tumours. They may be offered when surgery is not possible or as an alternative to it. Microwave heats a larger zone faster than radiofrequency in many settings, and the two are often used in similar cases.
Heat can injure nearby bowel, bile ducts and vessels. Blood flow can cool the edge of a tumour near a vessel and leave cancer cells behind.
Practical points for travel
Most patients stay for a short period for the procedure and a check scan, and then return for scans at home. Ask the treating team for the images and a written procedure report, and agree who will review follow-up scans.
What decides the choice
- Type of cancer and the evidence for it
- Tumour size, number and exact position
- Distance from vessels, bile ducts, bowel and nerves
- Your heart, liver and kidney function
- What other treatments you have had or may need
- What your doctors can safely deliver
Neither option is better in every case. It depends on the case. A reviewing specialist considers your scans before suggesting either. See our NanoKnife and ablation treatment pages for how we coordinate these reviews.
Related treatments
Microwave and radiofrequency ablation
How thermal ablation is used.
Read more →Related pages
Sources: NICE, Irreversible electroporation for treating pancreatic cancer (IPG579) · RadiologyInfo.org, Cryoablation and tumour ablation methods
Last reviewed: 12 November 2026. This page is general information, not medical advice.
Sino Health Link is an independent coordination service, not a hospital. We do not diagnose, prescribe or treat. Licensed doctors make all medical recommendations and decisions with you.