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Surgical Techniques

Scalpel

The scalpel is the traditional cancer surgery tool. Other tools such as needles, forceps, or scissors are involved in cancer diagnostic surgeries. However, these traditional cancer surgery tools are being replaced by new and more effective cancer surgical tools such as laser and radiation. These new surgical tools often result in less operative time, cause less pain to cancer patients, and reduce complications, such as scarring that sometimes occur with surgeries performed with traditional surgical tools.

A recent innovative cancer surgery tool, "Smart Scalpel," still in development, can even detect cancer cells. "Smart Scalpel," a dime-sized biological laser, can quickly identify a cell population that has abnormal protein content (as cancer cells usually do). This device should assist surgeons in cutting away malignant tissue while minimizing the amount of healthy tissue removed.

Cryosurgery

Cryosurgery (also called cryotherapy) is the use of extreme cold to destroy cancer cells. Traditionally, it has been used to treat external tumors, such as those on the skin, but recently some physicians have begun using it as a treatment for tumors that occur inside the body. Cryosurgery for internal tumors is increasing in popularity as a result of developments in technology over the past several years.

For external tumors, liquid nitrogen (-196 degrees Celsius, -320.8 degrees Fahrenheit) is applied directly to the cancer cells or tissue with a cotton swab or spraying device. For internal tumors, liquid nitrogen is circulated through an instrument called a cryoprobe, which is placed in contact with the tumor. To guide the cryoprobe and to monitor the freezing of the cells, the physician uses ultrasound (computerized moving pictures of the body generated by high-frequency sound waves). By using ultrasound, physicians hope to spare nearby healthy tissue.

Cryosurgery often involves a cycle of treatments in which the tumor is frozen, allowed to thaw, and then refrozen.

Advantages of Cryosurgery:

  1. Minimally invasive--no blood loss, no surgical incision, and can be done as an outpatient.
  2. Favorable success rates and less complications--less complications than open surgery.
  3. Short recuperation period.
  4. Procedure can be repeated if the first cryosurgery has failed.
  5. Radiation therapy or radical surgery is still an option if the cryosurgery fails.
  6. Cost is less than traditional treatment.

Electrocauterization Surgery

Cauterization is the process of destroying tissue by using chemical corrosion, electricity, or heat. Electrocautery is done using a small probe, which has an electric current running through it, to cauterize (burn or destroy) the tissue.

Electrocautery is a safe procedure and is routinely used in surgery to burn unwanted or harmful tissue. It is also effectively used to reduce or stop hemorrhaging by "burning" the bleeding blood vessels (seals them off). Various types, shapes, and sizes of tips (probes) are available for specific treatments.

A specific type of electrocautery is fulguration, sometimes called electrodesiccation. Electrodesiccation is the destruction of tissue with a diathermy instrument. Electrodesiccation is particularly useful inside the bladder. Bladder electrodesiccation is performed via the urethra and viewed through a cystoscope.

Laser Surgery

L-A-S-E-R stands for Light Amplification by Stimulated Emission of Radiation. Through a complicated electronic process, a beam of light is produced which has special properties. This light is all one wavelength; that is, it is all one color of the spectrum. The light is focused so that all of its rays are traveling in the same direction. In a similar fashion, you might use the lens of a magnifying glass to focus rays of sunlight to a point.

Lasers are used for many reasons. In many instances, lasers can improve the precision of the surgeon with finely focused beams of light. Some lasers can reduce bleeding by coagulating blood vessels as they cut tissue. Others can be aimed down narrow passages or sent down fiber-optic channels in endoscopes to reach areas that are otherwise inaccessible.

A new trend in laser surgery is to use the special properties of different wavelengths of laser light to selectively treat different problems. For instance, a yellow laser light absorbed by the red blood cells of a birthmark called a "portwine stain" can result in the selective destruction of the birthmark without affecting the skin cells around it. The result is that scarring of the remaining normal skin is lessened or avoided. In another instance of selective laser treatment, drugs that are retained by tumors are infused into the body and activated by lasers to destroy only the tumor, preserving normal structures.

In many instances, the cost of medical care can be reduced by lasers. Through their use, many procedures that previously required hospital admission can be done on an outpatient basis.

Photodynamic Therapy (PDT)

PDT is a revolutionary medical technology that uses lasers to activate light-sensitive pharmaceuticals to treat cancer (and other diseases) in a minimally-invasive manner.

PDT is considered to be cancer-directed surgery, and there are specific codes in the surgery data fields for PDT of various primary sites.

PDT works as follows:

  1. The patient is injected intravenously with a light-sensitive drug (most often, "photofrin").
  2. The drug is retained by malignant tissue, remaining inactive until exposed to a specific wavelength of laser light.
  3. Laser energy is directed to the site through a flexible fiberoptic device that allows the laser to be targeted precisely at the site.
  4. When activated by the lasers' light energy, the drug creates a toxic form of oxygen that destroys the cancerous cells with minimal damage to surrounding healthy cells.

En Bloc Resection

An en bloc resection is a surgical procedure in which a lesion and surrounding tissues are removed. "En bloc" or "in continuity with" means that all of the tissues were removed during the same procedure, but not necessarily in a single specimen.