Imagine cancer surgery with no scalpel and with promising patient outcomes. It’s arrived at Novant Health Forsyth Medical Center in Winston-Salem.
Forsyth is the first hospital in the Carolinas to offer histotripsy, a noninvasive method to destroy liver tumors without surgery.
The technique uses high-intensity ultrasound waves to shatter tumor cells while minimizing damage to surrounding tissues. Patients typically return home the same day or the following day.
“Where this technology really shines is its ability to fracture liver tumor cells without destroying the scaffolding of the tissues in which the tumor grows,” said Dr. David Sindram with Novant Health Cancer Institute - Forsyth. “The blood vessels and other structures remain intact and the patient does not require any sort of incision, which lessens hospitalization time.”
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Sindram, a surgeon who has treated cancers of the liver, pancreas and bile duct for more than 17 years, considers histotripsy a breakthrough treatment that will attract liver cancer patients throughout the Carolinas.
He has visited the Minneapolis-area headquarters of HistoSonics, makers of the histotripsy device and attended conferences of early adopters of the technology in United States, he said. “I’m really excited for us to be on the forefront and help shape where this technology goes.”
How does the histotripsy work?
After using ultrasound imaging to identify the exact location of the tumor, the physician uses a robot-controlled device to point an array of intersecting ultrasound waves at the lesion. Think of the movie “Ghostbusters,” Sindram said. “The individual rays from their guns were effective. But the moment they crossed beams, that’s when they became very powerful.”
The ultrasound waves create “bubble clouds” from gases in the targeted tissue. The bubbles break down the tumor, causing it to dissolve. A CT scan or magnetic resonance imaging (MRI) is required a month after the procedure to confirm results. Most tumors can be destroyed in a single treatment, according to HistoSonics, though some cases will require multiple sessions.
Who is a candidate for histotripsy?
As long as the liver tumor is visible on ultrasound, a patient is a candidate for histotripsy. The physician can treat several liver tumors in one session.
Histotripsy has been studied in laboratories for several decades. Clinical trials began in the U.S. in 2018, and the procedure was approved by the U.S. Food and Drug Administration (FDA) in October 2023. Since then, more than 1,000 tumors have been treated in the United States with histotripsy.
A 2025 study in the Annals of Surgery showed a high rate of success. It found that histotripsy produced a 90% “local tumor control rate” one year following treatment. In other words, in 9 out of 10 patients, the cancer didn't come back in the treated area after a year.
Are there side effects with histotripsy?
While any medical procedure has the possibility of side effects, Sindram said histotripsy has been remarkable in the lack of reported side effects compared to other procedures that surgically remove body tissue.
Does insurance cover the histotripsy procedure?
Medicaid and Medicare have approved the treatment, and several major insurance companies have added this procedure to their coverage. Sindram anticipates that most insurers will cover the procedure as they learn about it. “Histotripsy will eventually become the standard of care,” he predicted.
What has been the response from histotripsy patients in the U.S.?
Patients where the technology has been available have embraced it as a less painful alternative to incisions and surgery.
Sindram hopes to offer the procedure at additional Novant Health medical centers beyond Winston-Salem in the future.
Can histotripsy work on other types of tumors?
Histotripsy holds promise for kidney and pancreatic tumors. A scientific trial studying its effectiveness on kidney tumors has concluded, and the FDA’s assessment is expected soon. Based on preliminary data, Sindram believes the FDA will approve the procedure for kidney tumors.
Pancreas tumors are among the most difficult to treat. Operations on pancreatic lesions are “some of the most damaging to patients and the most difficult to go through,” Sindram said.
Trials are underway to determine the procedure’s safety and efficacy for pancreatic tumors.
“If we can use this technology to erase tumors out of the pancreas,” Sindram said, “that will be a shift in my profession. I’m thrilled to think about what might be possible.”
