Irreversible Electroporation for Tonsillar Ablation in Adults

Introduction: Irreversible electroporation (IRE) is an emerging technology for non-thermal ablation of tissue. A pulsed high energy electrical field is applied to the target tissue through electrodes causing disruption of ion channels resulting in cell apoptosis and tissue ablation. The objective of this study is to evaluate safety and efficacy of IRE for ablation of tonsils in adults

Methods: The study is a prospective case series, before and after intervention. Included were 23 adult patients referred for tonsillectomy in an academic medical center between May to September 2024 and were followed up for 3 months. The procedures were performed under general anesthesia or sedation. IRE was applied to the tonsils using the ENTireTM system. Pain was evaluated daily during the first week through telephone interviews and on each follow up visit with a subjective pain scale (0 = no pain – 10 = unbearable pain). Tonsil size was evaluated using the Brodsky scale and The Tonsil and Adenoid Health Status Instrument (TAHSI) questionnaire was administered at baseline and at 3 months.

Results: 23 adult patients (mean age: 36.5 ± 14.0; mean BMI: 25.5±4.1) were included. No bleeding was observed intra or postoperatively. Operating time was less than 5 minutes in all cases. A pain scale score below 2 was reported 4.5±1.7 days after intervention. Following 3 months, significant reduction in tonsillar size was observed from 2.4±0.9 pre-intervention to 1.3±1.0 post-intervention (p < 0.001). TAHSI scores decreased from 17.7±13.0 to 0.96±1.7 (p < 0.001).

Conclusions: This is the first clinical study investigating the use of IRE for tonsillar ablation. IRE for tonsillar ablation shows promise as a minimally invasive and short procedure for reducing the size and symptoms of tonsillar hypertrophy with negligible bleeding and significantly less pain. Further multi-center studies are in progress to evaluate its long- term efficacy, including the pediatric population.