Excision Surgery Information

According to Stedman's Medical Dictionary, the primary definition of excision is "the act of cutting out; the surgical removal of part or all of a structure or organ." The word excision is often used interchangeably with the word resection. Both terms are used often in surgery since many surgeries are intended to remove part of the body, either a diseased organ or tissue or a tumor of some sort, for example.

An excision can be done either for diagnostic purposes, for treatment purposes, or both. In acute appendicitis, for example, the diagnosis of the disease has been made by the time surgery begins; the patient's clinical history, physical exam, bloodwork, and radiographic studies all point to an inflamed appendix before surgery is considered. Therefore when the appendix is removed by excision, it is for treatment only (although the excised appendix will be sent to a pathologist for confirmation of the diagnosis).

An example of a diagnostic excision is in the case of a biopsy. Under certain circumstances part of an abnormal growth may be cut out (an excision) and studied by a pathologist. The pathologist will look and the material harvested during the excision for signs of cancer, infection, inflammation, or other things indicative of disease.

When a surgical excision is made it is often done with the goal of both diagnosis and treatment. This is best illustrated by a surgical excision that is performed for suspected cancer. Many cancers, such as lung cancer, breast cancer, and skin cancer are completely removed at the time of biopsy. During the excision, the abnormal tissue is removed along with a border of presumably healthy tissue on all sides. The tissue from the excision will be closely scrutinized for diagnosis, but, since it was removed along with healthy tissue, if the excised material turned out to be cancerous, the excision was also therapeutic.

While there are many examples of surgical excision, newer techniques have been developed that allow excision without disrupting much skin, in other words, they are minimally invasive. One example would be the tissue that is taken during colonoscopy. A colonoscope is advanced along the colon and a gastroenterologist identifies any abnormalities on the wall of the large intestine. These abnormalities could include arteriovenous malformations or polyps, for instance. When these are seen through the small camera in the end of the colonoscope, small instruments can be used to perform an excision of the abnormal tissue. As with all excisions, the tissue is sent to the lab for analysis.

Finally, gynecologists routinely perform excisions as part of their practice. The cervix is the muscular tissue that is at the bottom of the uterus and is suspended in the vagina. The cervix is prone to cancer if exposed to the nearly ubiquitous human papillomavirus. Thus if the cervix appears to be abnormal based on a Pap smear, the gynecologist will perform an excision of the cervix (or part of the cervix) to remove any abnormal cells, including cancerous or precancerous cells. Often this excision is aided by the use of a loop electrosurgical excision procedure or LEEP.