No scalpels, no scars: complex non-invasive surgery the Israeli way

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The da Vinci Surgical System

The da Vinci Surgical System

With the advances in robot-assisted surgery, complex procedures such as organ transplants and tumour excisions will soon involve minimally or non- invasive surgery and radiation therapy. High-precision technologies – like the da Vinci Surgical System – can save the surgeon time, and the healthcare provider money, by reducing the number of prolonged hospital stays and the risk of complications normally associated with open surgery (see medeuronet magazine article: “Robotic Surgery: New and Improved or New and the Same?“).

A similar device called Exablate Neuro – developed by Israeli medtech company InSightec – promises a completely non-invasive approach to cancer treatment and brain surgery through the combined use of Magnetic Resonance Imaging (MRI) and high-intensity ultrasound. The MRI technology provides high-resolution images to help determine the treatment area and monitors temperatures during the surgery. The energy produced by the focused ultrasound waves generates a heat of up to 85°C that can ablate affected body tissue in just one session.

Eyal Zadicario

During the procedure, up to 1,000 ultrasound rays are focused on the point of treatment, thus acting as what InSightec’s General Manager Eyal Zadicario (pictured left) describes as a ‘virtual knife’. ‘The MRI serves as the eyes of the surgeon, and the ultrasound replaces the scalpel or catheter he would need to insert into the body,’ he explains. Exablate Neuro enables the surgeon to perform a safe and effective non-invasive surgery with little or no damage to the surrounding tissue and with minimal side effects for the patient.

Broadening Exablate’s application

InSightec has been developing Exablate for the past 17 years, Zadicario explains, with its first application developed to treat uterine conditions over a decade ago. As the treatment assured a quick and painless recovery for patients, experts at InSightec further developed Exablate’s applications to include orthopaedic conditions such as bone metastases and osteoarthritis.

‘But the Holy Grail of non-invasiveness is in neurosurgery,’ says Zadicario. ‘Here you can do brain surgery without ever penetrating the skull and therefore remove any of the risks of open brain surgery.’

After a nine-year development process, Exablate Neuro is finally CE-marked and FDA-approved, and already installed in hospitals in countries around the world including Italy, Spain and Switzerland. ‘The device is currently able to treat essential tremor by focusing the ultrasound into a very precise and tiny spot in the centre of the brain, which causes the tremor, and ablating it. So the tremor is completely supressed after one visit to the clinic, after one procedure,’ Zadicario explains. The procedure is called thalamotomy and targets the ultrasound to a focal point in the Vim nucleus of the thalamus, and it doesn’t require any ionising radiation, incisions or implants, so the patient lies fully conscious in the MRI scanner throughout the treatment.

An alternative to aggressive treatments

‘The next application for Exablate Neuro will be in Parkinson’s patients; we are currently running clinical trials. By understanding its abilities, we aim to trial this technology on brain tumours and epilepsy next, as both conditions currently see a very aggressive open surgery as the only treatment option,’ says Zadicario.

InSightec’s vision for the longer term. However, goes well beyond tissue treatment. Pre-clinical trials are already being conducted to learn how ultrasound could significantly improve the way that drugs affect the brain.

Insightech’s focused ultrasound therapy

‘Basically, with the aid of ultrasound, you make the uptake of drugs much more effective in the brain,’ Zadicario says. Drugs today are not always totally effective in the brain because of the natural block created by the blood-brain barrier. It prevents drugs from entering the brain and therefore makes them a lot less effective here than in other parts of the body. But InSightec’s trial results have shown that focused ultrasound can very selectively open up the blood-brain barrier and enable drugs to get into the brain in a much higher concentration.

‘This can completely change how the toxicity of drugs could be managed in terms of chemotherapy and can significantly increase or improve the efficacy of existing or new drugs,’ he adds.

Israel’s medtech revolution

Though a small nation, Israel’s economy is bolstered by an innovative medtech culture, with more than 400 companies actively working on medical devices. According to Zadicario, there are many programmes around the country that bring companies and academia together to collaborate on developing and testing new technologies.

‘These programmes have enabled us do a lot of unique engineering both in terms of MRI and ultrasound probes and electronics. There is a lot of medical imaging technology developed here – that’s a main aspect of our collaboration: algorithms for image processing,’ he says. ’We’re also part of an Israeli consortium looking to expand this technology’s application, We want to integrate our ultrasound treatment into a brain monitoring technology currently being developed by another company.’

InSightec’s Exablate system has recently been used in a successful study by London’s Imperial College Healthcare NHS Trust to determine the device’s efficiency in prostate cancer treatment. With that in mind who knows what’s next, or how the technology could change the face of healthcare in the future?

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