Minimally Invasive Surgery for Cancer

For several decades, conventional or ‘open’ surgery had been used to treat cancer. Surgeons, surgically operated on the cancerous tissue and removed it. Alternatively, the afflicted part of the body would be treated by chemotherapy.The ill-effects of chemotherapy are well-documented, making it, an unpopular option.

• The disadvantages of open surgery are innumerable:
• It puts the patient at potential risk
• The incisions made are large
• Recovery time therefore involves longer convalescence periods
• During open surgery, the possibility of adjacent tissues and organs being accidentally affected, is possible
• Innumerable sutures are required to close the incision
• Unfortunately however, open surgery is still the only option in some cases.

For most cases, minimally invasive surgery (MIS) has emerged as a better option. In MIS, advanced incision techniques combined with sophisticated computer imaging (equipment and software)hasdone away with the need for the scalpel. Instead, tiny incisions or keyhole incisions are made in the body, to insert long, thin tubesthat are fitted with powerful, video cameras or scopes. As the scopeapproaches the cancerous tissue, the cameras project a real-time, real-size image. With the aid of the image guiding system,the surgeon makes a precise incision and draws out the tissue through one of the tubes that have been inserted, into the body. The procedure is done under general or local anesthesia depending on the case. MIS which is nearly three decades old has become popular with time and is replacing open surgery for a wide variety of cancers.

Benefits of minimally invasive surgery

• Smaller incisions – ‘keyhole’ openings
• Less damage to surrounding healthy tissue
• Less blood loss and need for transfusion
• Decreased post-operative pain and need for postoperative pain medication
• Less scarring and improved cosmetic appearance
• Earlier resumption of regular diet
• Quicker recovery and return to normal activities
• Fewer side effects
• Improved healing
• Shorter hospital stays
• Shorter recovery time

MIS types and Techniques

The enormous benefits and cost-effectiveness has made minimally invasive surgery, a more preferred surgical option. Diagnostic techniques keep improving in tandem with the research and advancement in technology.

Laparoscopic Surgery: Of all the techniques, Laparoscopy is the most versatile and effective. It is used to treat most of the cancers such as prostate, esophagus, bladder, lung, colon, liver, rectum, pancreas, bile-duct, gall-bladder and stomach. A laparoscope comprises of ‘trocars’, a pen-shaped device that is sharp at one end and encased within a tube. The trocars are inserted into “keyhole” incisions made. The surgeon views the inside of the organs with the help of a video camera, mounted on a thin metal tube that has been passed through one of the incisions. The surgeon with specialized instruments performs the surgery, with the help of the projected, magnified images on to computer screens.

• Da Vinci® Robotic Surgery:In this procedure, a robot's arms holds the surgical tools, while the surgeon controls them sitting ata console, looking at a three-dimensional view of the internal organs
• Transoral Laser Surgery: An endoscope is advanced through the mouth and laser energy is delivered through it, in order to break up and extract the timorous tissues
• Video-Assisted Thoracic Surgery (VATS): During this procedure, a laparoscope is inserted through a small cut made between the ribs, and tumors present in the lungs or esophagus are extracted
• High Intensity Focused Ultrasound (HIFU):High levels of ultrasound energy are focused onto narrow areas of the cancerous tissue, iteratively. This generates intense heat, which then destroys the tissue

Advanced and specialized treatment options are available with the quantum leaps made by medical technology, to treat many patients. Across medical centers today, multidisciplinary teams function to provide the best options to patients suffering from cancer. Cancer is curable and treatable when caught in the early stages, consequently periodic screening is advisable.

Types of Biopsy available for Cancer Treatment

Why is a Biopsy Performed?

Biopsies are performed to help diagnose the presence of cancer. Generally a biopsy is performed when a patient has symptoms of a lump or abnormal swelling on some part of their body. During the procedure a sample of the tissue is removed from the abnormal growth that is present on the patient’s body. As a part of the information gathering process that every cancer patient must undertake, understanding the different types of biopsies, is as important as the rest of the information on cancer.

State-of-the-art equipment like X-ray machines, Magnetic Resonance Imaging (MRI) and CAT Scans, help determine the presence and location of an abnormal growth which could be benign or malignant. To determine the exact type and nature of the abnormal growth, a biopsy is performed, where the tissue sample that is removed, is studied under a microscope.

This procedure basically is performed with the use of a long biopsy needle inserted into the abnormal growth, to remove a sample. It is normally a minimally invasive procedure, but in cases where necessary, the traditional open type of biopsy is also performed. There are several types of biopsies and each has its advantages and disadvantages. Depending on many factors, such as the general health of the patient, the location of the abnormal growth (tumor, lump, lesion), the size of the growth, the suspicious nature of the tumor, and the number of tumors present, the doctor in consultation with you, will opt for the biopsy procedure, best suited for you. 

Types of Biopsies:

Given below are the broad types of biopsies performed to diagnose cancer.

• Core Biopsy or core needle biopsy
• Needle Biopsy
• Excision or Incisional Biopsy
• Endoscopic Biopsy
• Laparoscopic Biopsy
• Skin Biopsy
• Sentinel Lymph Node Biopsy

Needle Biopsy is of two types:

• Fine needle or fine needle aspiration biopsy
• Core Biopsy or core needle biopsy

Ø  In the Fine Needle Biopsy procedure, a very thin needle together with a syringe is used to draw out the tissue sample, comprising of a small amount of fluid and tissue, from the abnormal growth. The needle is guided into the area where the tumor is located with the help of a fluoroscopy (x-ray imaging system), in cases where the tumor is deep seated within the body. This is a minimally invasive procedure

Ø  In the core needle biopsy, a much larger needle than the fine needle is used to draw out tissue measuring about half an inch long and 1/16^th inch in width from the tumor. Before the procedure, local anesthesia is administrated. Similar to a fine needle biopsy, imaging systems are used during the procedure

Ø  In the Endoscopic procedure, a flexible, thin tube with a light and camera, is inserted into the body to extract tissue samples. Different types of endoscopic apparatus are used for tumors present in different parts of the body

Ø  Laparoscopy is a minimally invasive surgery performed in the abdomen area. A laparoscope is similar to an endoscope but the scope used is slightly different. This is also known as keyhole form of surgery, as the incision made is very small. The laparoscope is then passed through the opening to study the internal parts of the body. A laparoscope used on the chest is known as thoracoscopy and mediastinoscopy

Ø  Depending on the type of skin tumor, doctors use, different methods to do a skin biopsy. In the Shave Biopsy, skin is scraped off the surface or outer layer of the skin and this type of biopsy is performed when the patient is suspected to have either basal cell or squamous cell tumors. In melanomas of the skin, a Punch biopsy is performed

Ø  A surgeon uses the Sentinel Lymph Node biopsy to map the exact lymph node that needs to be removed