What is surgical excision? How and why 10 common procedures are performed

By Cristiano Antonino On Aug 8, 2022

Excision means ‘to surgically remove’. In medicine, the term describes the removal of a growth, tissue, organ or bone using a scalpel, laser or other cutting instrument

Unlike the removal of a tissue sample or body part, excision describes the removal of the entire portion of a structure.

For example, lumpectomy is an excisional biopsy that removes the entire breast tumour.

It is different from a core biopsy, which removes only part of the lump.1

Surgeries used to remove a specific part of the body often end with the suffix ‘-ectomy’.

Appendectomy (used to remove the appendix) and cholecystectomy (removal of the gallbladder) are two such examples.

This article describes 10 different excisional procedures used to diagnose or treat medical conditions.

It also lists the different medical professionals who routinely perform excision procedures.

Why an excision is performed

Surgical excision is often used with the intention of treating a medical condition.

However, after the operation, further treatments, called adjuvant therapies, may be prescribed to prevent recurrence of the disease.

For example, a person may receive adjuvant radiotherapy after the removal of a tumour to ensure that all remaining cancer cells are killed.

On the other hand, neoadjuvant therapy can be used before surgery to make it less invasive and more effective.

For example, neoadjuvant chemotherapy may be prescribed before surgery to shrink the tumour and make it easy to remove without complications.2

Who performs a surgical excision?

Surgical excisions are usually performed by surgeons, some of whom are general surgeons capable of performing procedures such as appendectomies and cholecystectomies.

Others have specific training and are certified to treat specific organ systems.

Examples of specialists who perform excisions are:

Neurosurgeons, who treat diseases of the brain and central nervous system.
Surgical oncologists, who treat cancer
Orthopaedic surgeons, who specialise in disorders of the bones and joints
Cardiothoracic surgeons, who treat diseases of the heart, lungs, oesophagus and other organs of the thorax.
Excisions can be performed in a hospital or on an outpatient basis in an office, clinic or surgery centre.

10 Examples of excision operations

Besides lumpectomy, appendectomy and cholecystectomy, there are other excisional procedures used to diagnose or treat a disease (or both).

Some excisions are performed as traditional open surgeries, with a scalpel and a large incision.

Others are performed laparoscopically, i.e. with specialised instruments that are manipulated through smaller incisions.

Depending on the procedure, local, regional or general anaesthesia, or no anaesthesia, may be used.

Excisional skin biopsy

This procedure is typically recommended for certain skin cancers, including low- and high-risk basal cell carcinoma, low- and high-risk squamous cell carcinoma, Merkel cell carcinoma and thin melanoma3.

Also known as wide local incision, excisional skin biopsy involves the removal of the tumour and part of the surrounding normal tissue (called the clinical margin). The size of the margin depends on the thickness of the tumour.3

In some cases, a skin graft or flap is used to cover the wound.

Other wounds are simply closed with stitches.3

Tumour craniotomy with excision

This operation involves removing a section of bone from the skull (craniotomy) to gain access to the brain so that a tumour can be removed.

The tumour may be benign (non-cancerous) or malignant (cancerous).4

Almost all tumour craniotomies are performed using a computer navigation technique known as stereotaxis.

This improves the accuracy of the operation and reduces the size of the incision needed to perform the excision.4

Tumour excision involves the use of specialised scalpels and scissors, a suction device called an ultrasonic aspirator and special microscopes.4

Excision of myxoma

This is the surgical excision of a benign cardiac tumour called a myxoma, usually located in the upper left chamber of the heart. Myxomas account for about 50 per cent of all cardiac tumours.5

Surgical excision is the only form of treatment for myxomas.

As myxomas are very fragile and vulnerable to rupture, their removal usually requires open surgery to provide clearer access to the heart chambers.5

Excision of venous malformations

This is one of two therapeutic approaches used to remove venous malformations.

These are caused by lesions in the blood vessels that are present at birth but can grow over time to cause painful, hardened blood clots called phlebolites.6

Surgical treatment of venous malformations involves the removal of abnormal veins and some of the tissue surrounding them.

Sclerotherapy, the other treatment approach, involves injecting chemicals into the veins to make them narrow.

It is often used preventively to reduce bleeding and make it easier to remove the malformation.6

Excision of bone tumours

This surgical procedure is used not only to remove malignant bone tumours, but also benign tumours that can become malignant.

Removal of the tumour helps reduce the risk of bone fractures.7

If cancer is present, surgical removal of the tumour is often followed by radiotherapy and/or chemotherapy to prevent the spread of cancer and help preserve the limb.

A metal plate or transplanted bone may be used to stabilise and strengthen the bone.7

Colonoscopy with polypectomy

This is a procedure commonly performed during an endoscopic examination of the colon (called colonoscopy).

As a precaution, found polyps are removed on the off chance that they will become cancerous.9

The procedure is usually performed under controlled anaesthesia (MAC), which causes a ‘twilight sleep’.

If a larger polyp is detected, an instrument on the scope can detach it and send it to the lab for evaluation.

Smaller polyps can also be removed, although some can be marked with tattoo ink so that they can be easily identified and examined again during future colonoscopies.9

Endometrial excision

This is the complete removal of uterine tissue that has grown outside the uterus in people with endometriosis.10

Robotic laparoscopic surgery is commonly used for endometrial excision.

This involves inserting specialised instruments through tiny incisions in the skin.

The instruments are manipulated outside the body with master controls.

Excess tissue is then destroyed with intense heat (called fulguration).10

Orchidectomy

Orchiectomy is the surgical removal of one or both testicles.

It is mainly used to treat testicular cancer or advanced prostate cancer.11

Orchiectomy begins with an incision just above the pubic area.

The testicle, spermatic cord and tumour are then removed from the scrotum and extracted through the opening.

The operation can be performed laparoscopically or open.11

Excision of the acromioclavicular joint

This is a surgical procedure used to remove a damaged acromioclavicular joint (ACJ) located where the clavicle meets the scapula.

The aim is to do this without destabilising the shoulder itself12.

Surgery is generally used when the joint is severely damaged by arthritis or an injury.

Using a specialised scope (called an arthroscope) and laparoscopic instruments, the surgeon shaves and smooths the worn surfaces of the joint before cutting and removing a piece of the clavicle.12

The joint remains stabilised by ligaments that bridge the severed section of bone.12

References:

MedlinePlus. Breast lump removal.
Masood S. Neoadjuvant chemotherapy in breast cancers. Womens Health (Lond). 2016;12(5):480-91. doi:10.1177/1745505716677139
Nahhas AF, Scarborough CA, Trotter S. A review of the global guidelines on surgical margins for nonmelanoma skin cancers. J Clin Aesthet Dermatol. 2017 Apr; 0(4):37–46.
Young RM, Jamshidi A, Davis G, Sherman JH. Current trends in the surgical management and treatment of adult glioblastoma. Ann Transl Med. 2015 Jun;3(9):121. doi:10.3978/j.issn.2305-5839.2015.05.10
Karabinis A, Samanidis G, Khoury M, Stavridis G, Perreas K. Clinical presentation and treatment of cardiac myxoma in 153 patients. Medicine (Baltimore). 2018 Sep;97(37):e12397. doi:10.1097/MD.0000000000012397
Behravesh S, Yakes W, Gupta N. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther. 2016 Dec;6(6):557–69. doi:10.21037/cdt.2016.11.10
Rajani R, Gibbs CP. Treatment of bone tumors. Surg Pathol Clin. 2012 Mar 1;5(1):301–18. doi:10.1016/j.path.2011.07.015
Gohar MS, Niazi SA, Niazi SB. Functional endoscopic sinus surgery as a primary modality of treatment for primary and recurrent nasal polyposis. Pak J Med Sci. 2017 Mar-Apr;33(2):380–2. doi:10.12669/pjms.332.11800
Bhagatwala J, Singhal A, Aldrugh S, Sherid M, Sifuentes H, Sridhar S. Colonoscopy — indications and contraindications. In: Screening Colorectal Cancer Colonoscopy [Intech Open].
Zanelotti A, DeCherney AH. Surgery and endometriosis. Clin Obstet Gynecol. 2017 Sep;60(3):477–84. doi:10.1097/GRF.0000000000000291
Okoye E, Saikali SW. Orchiectomy. In: StatPearls [Internet].
Kim JY, Bryant S, Gardner B, et al. Distal clavicle excision for acromioclavicular joint osteoarthritis using fluoroscopic Kirschner wire guide. Arthrosc Tech. 2021 Feb;10(2):e359–e365. doi:10.1016/j.eats.2020.10.010
National Cancer Institute. Breast cancer surgery chart.
American Cancer Society. Surgery for basal and squamous cell skin cancers.
American Society of Plastic Surgeons. Tattoo removal: Eliminate unwanted tattoos.