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Health Matters: Providence Mission Hospital | 7 Liver Surgery Without Cutting Dr. Ahmad Abou Abbass and Dr. Kevin Burns will be the first medical team in California to use Edison, an astonishing new technology that destroys liver tumors without surgical excision. T o say that interventional radiologist Kevin Burns, MD, and general surgeon Ahmad Abou Abbass, MD, are excited about the arrival of HistoSonics' new Edison System at Providence Mission Hospital is an understatement: They are anticipating a revolution in the treatment of liver tumors and, most important, who can be treated for them. Edison is a creation of HistoSonics Inc., a company formed in 2009 after researchers at the University of Michigan discovered and named the process now known as "histotripsy." Rather than use radiation or heat to destroy diseased tissue, histotripsy uses intense sound energy in pulsed waves. The precisely targeted pulsed ultrasound causes "bubble clouds" to form. The microbubble clouds develop and collapse rapidly, imploding only the tumor cells. The histotripsy process is entirely noninvasive, using beams of high- energy ultrasound from Edison's robot-assisted system directed into the patient's body through a conductive medium. The physician performing the procedure can watch and control the action in real time with Edison's integrated imaging. The technology was cleared by the Food and Drug Administration in October 2023 for use in patients with cancerous or benign liver tumors. Histotripsy is done under general anesthesia to minimize the patient's movement, but it isn't painful. The noninvasive procedure minimizes the risk of infection, bleeding or other complications. NONINVASIVE 'SURGERY' "Because it's noninvasive," says Dr. Burns, "it opens up treatment to a host of patients who otherwise wouldn't be candidates. There's no incision, no needles, no bleeding—not even with someone on blood thinners. There's no other treatment like this." He also notes that the treatment is complementary to therapeutic regimens such as chemotherapy and can be used to fight metastatic cancer that's spread to the liver. "Mission is the first site in California to have it," Dr. Burns says. When Edison arrived in February, Mission Hospital became the eighth hospital in the world able to offer the treatment. Dr. Abbass, who is director of the Hepatobiliary program at Mission Hospital, adds simply, "It's going to be game-changing. This is going to be huge." Like Dr. Burns, he anticipates being able to help a whole new population of patients, in particular people who are too frail or sick to withstand conventional surgery or have exhausted other treatment options, such as radiation therapy. Dr. Burns notes that Edison can in theory be used to target tumors in areas of the body that are either difficult to access with conventional surgery, such as the pancreas, or delicate to resect, such as the thyroid. Both doctors are excited about the possibility of using Edison in other parts of the body. HistoSonics is already working toward expanding its system's use in tumor destruction, and clinical trials are either in development or underway for brain, kidney, pancreas and prostate tumors. MORE GOOD NEWS But Edison's potential for healing patients doesn't stop with the destruction of a malignant tumor. After the tumor is liquefied by the sonic beam, molecular elements of it remain in the body. These subcellular fragments are too small to allow the targeted cancer to spread and regrow. Making sure that only nonviable particles remain is a practice learned the hard way from an older surgical treatment known as "morcellation." In morcellation, surgeons would grind up uterine tumors in place, but if there was cancerous tissue present, the fragments of it dispersed, potentially seeding the cancer elsewhere. HistoSonics' research suggests an opposite effect may occur, in which the body's immune system begins to recognize aspects of the tumor molecules as unwelcome invaders and starts building an immune defense. At this point, the immune-response theory is just that—a theory—but it's a tantalizing one. "There are no viable cells left after sonic ablation. It's a slurry," explains Dr. Burns. "This slurry may enable the body's own immune system to help attack cancer cells elsewhere in the body." "The possibilities for immune response are very promising," says Dr. Abbass. But even without the bonus of immune-system activation, Edison does indeed promise to be a game changer. HOW DONORS DRIVE INNOVATION Thanks to the steadfast engagement of our community, Providence Mission Hospital is on the forefront of innovation and exceptional care. "We are able to offer a level of advanced care typically found at academic medical centers thanks to philanthropy," says Mission Chief Executive Seth Teigen. As new technologies such as histotripsy emerge, philanthropy enables us to bring innovation to the community and hope and healing to our patients and their families. To contribute to the advancement of care at Providence Mission Hospital, please contact Nicole Balsamo, chief philanthropy officer, at nicole.balsamo@stjoe.org or 949-364-7783. To learn more about histotripsy and eligibility, call OC Surgeons at 949-364-1007.

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