EXCISION: WHEN IT IS USED, TYPES AND INSTRUMENTS - MEDICINE - 2025

Excision is a medical term that refers to the removal of an organ or tissue from the human body. The concept encompasses both the taking of a biopsy sample and the removal of a damaged or dysfunctional organ. This procedure constitutes, then, a surgical technique that must be performed by trained personnel.

Surgical techniques are as old as mankind. The development of surgery was born from the need to perform an instrumental procedure to cure a disease. Trepanation - extraction of a cranial fragment for therapeutic purposes - is a clear example of this.

Source: Pixabay.com

Excision is a surgical procedure that requires compliance with certain rules to achieve its objective. It is necessary to have adequate instruments, to respect the aseptic norms and the anesthesia or sedation of the patient.

There are terms related to excision such as resection, excision, ablation, or excisional biopsy. All of them explain the extraction -through surgery- of a tissue from the human body, partially or totally.

The suffix -ectomy that is associated with the name of an organ or tissue, serves to define the extraction of these. An example is cholecystectomy or surgery to remove the gallbladder.

When is it used?

Source: osan.af.mil

Procedures that involve tissue excision are intended to remove tissue when it is abnormal, damaged, or not working. In this sense, such procedures are useful for both therapeutic and diagnostic purposes.

There are pathologies, such as tumors, that pose a problem that affects the normal life of a patient. The indication for any surgery -including the resection of an organ- is the risk to health or life.

Diagnostic procedure

The biopsy represents one of the most accurate diagnostic procedures that exist. The observation of tissue samples -both macroscopically and microscopically- shows alterations in them, and the need for treatment. It is a useful tool to determine both the damage and the viability of a tissue.

To carry out this procedure, the cut and separation -exeresis- of a sample of the affected area is required. According to the resection performed, the biopsy is classified as excisional or incisional.

Excisional biopsy

It consists of the total removal of the lesion or affected tissue. In this case, the procedure is therapeutic and diagnostic. The result of the biopsy indicates whether further complementary treatments are necessary.

This technique is directly related to the concept of exeresis or excision.

Incisional biopsy

When a lesion is very extensive or a diagnosis needs clarification, this procedure is used. The objective is to take a representative sample of tissue for study and diagnosis. According to the result obtained, it is decided whether or not the complete resection of the lesion is appropriate.

Occasionally the sample required is so small that it only involves the use of needle aspiration.

Therapeutic procedure

It involves the execution of surgical techniques in order to remove injuries, damaged or unnecessary tissue from the body. The main utility of exeresis is to restore organic functioning and, consequently, the health of the individual.

There are countless procedures in which exeresis is used. The number of existing procedures is proportional to the types of injuries. In each case the applied technique will be different, according to the injury. It is used in both minor procedures and major surgeries.

Dentistry and oral-maxillo-facial surgery

In these disciplines its use is indicated both for tooth extractions and tumor resection. In maxillary and oral surgery, the repair of damaged areas sometimes requires the removal of the affected tissue.

Dermatology

Procedures are indicated for the removal of skin lesions and tumors. The onychectomy and matricectomy -indicated in the treatment of onychocryptosis- involve the partial or total extraction of the nails.

Caumatology and reconstructive surgery

Burns cause skin and soft tissue damage that must be removed to allow healing.

Surgery

The field of surgery is wide. Each surgical subspecialty has a procedure according to the specific area it dominates. Some examples of more frequent surgeries are:

- Removal of tumors from the nervous system.

- Adenoidectomy and tonsillectomy, also known as tonsillectomy.

- Thyroidectomy.

- Cholecystectomy.

- Splenectomy.

- Gastrectomy.

- Colectomy and hemi-colectomy.

- Appendectomy.

- Excision of benign tumors in different areas of the body

Oncology and Oncology Surgery

It involves the removal of malignant or carcinomatous tumors.

Gynecology

- Tumors in the gynecological area.

- Hysterectomy.

- Oophorectomy and salpingectomy, corresponding to the exeresis of the ovaries and annexes.

Traumatology and orthopedic surgery

The extraction of bone segments and joints for their prosthetic replacement. Amputations are considered a form of excision that involves the partial or total removal of a limb.

Urology

- Prostatectomy.

- Tumors of the urinary tract.

- Nephrectomy.

- Lithotripsy.

Transplant surgery

This discipline involves the complete removal of a damaged or non-functional organ. The purpose is the replacement by an organ that comes from a compatible donor.

Types

The diagnosis of a disease is important for making therapeutic decisions. For the removal of a damaged organ or tissue, the following must be taken into account:

- The role it performs.

- The morphological or functional alteration that its absence will produce.

- The importance it has for maintaining life, as in the case of the heart, lungs or kidneys.

- The physical appearance, aesthetics and possible deformities that could occur.

The excision or resection -both lesions and organs- can be divided according to their total and partial extension.

Total

It involves the complete resection or removal of an organ or tissue. Here the morphofunctional characteristics of the affected area are considered when deciding to perform the procedure. Tumors are almost always completely removed when their extension does not compromise vital areas or functions.

Thyroidectomy - exeresis of the thyroid gland - can be total, given oral hormone replacement. The uterus, ovaries, and adnexa are important but not vital organs and can be completely removed. In the same way the prostate in men.

Paired organs - such as lungs and kidneys - allow complete exeresis of one of them, while the other is functional.

Partial

It constitutes the resection of a portion of the affected tissue or organ, maintaining its function and occasionally its shape. Its use is intended for cases in which the lesion is localized and allows it to be removed without risk of recurrence. In the case of organs, we also speak of segmental resection or exeresis.

Partial removal of tumors is because their structure can spread to vital areas.

Instrumental

The exeresis, as a surgical procedure, implies the use of suitable instruments for its execution. This includes:

Basic or non-instrumental material

- Sterile lingerie, such as sheets and fields, in addition to gowns, hats, masks and boot covers.

- Gauze, compresses, and sterile gloves

- Syringes and needles.

- Anesthetics.

Basic instruments

Instruments for cutting or diaeresis

Useful for approaching the operative area, allowing the separation of the planes and access to the site of the injury. They also allow cutting of superficial and deep lesions.

- Scalpel, blade and scalpel handle.

- Metzembaum and Mayo scissors

- Electric scalpel, for cutting and coagulation. A variant used in neurosurgery is electro bipolar, with a more delicate and precise cut.

- Other instruments are used for cutting bone, for use in traumatology, neurosurgery and thoracic surgery.

Separators

Used to expand the operative area. They are divided into manual and fixed

- Deavers

- Farabeuf

- Malleable valves

- Richardson

- Senn Miller

-Fixed spacers such as Balfour, Gosset and Finochieto.

Other separators are used in special surgeries, such as Gelpy, Weitlaner, mastoid, Belkman Adson separators

Gripping or grasping

They are forceps used to fix or capture tissues

- Allis

- Judo-Allis

- Backhaus

- Flat and serrated dissection, which can be short or long.

- Flat and serrated Adson dissection

Hemostats

To occlude a blood vessel or stop tissue bleeding. They are generally articulated and lockable forceps. The electrosurgical unit is included in this group.

- Mosquito straight and curved

- Kelly straight and curved

- Kelly Adson straight and curvy

Instruments for synthesis or closure by planes

They allow the closure of the deep and superficial planes at the end of the surgical procedure.

- Needle carrier

- Needle sutures

- Suture thread

- Widow needles

- Metzembaum scissors

- Mayo scissors

- Cryles clamp

- Flat and serrated dissecting forceps.

Instruments for biopsies

- Needles for aspiration.

- Punch or punch.

References

1. Wiley Blackwell (Last act. 2015). Surgical techniques. Recovered from surgwiki.com
2. Wikipedia (Last rev 2018). Surgery. Recovered from en.wikipedia.org.
3. Whitlock, J (updated 2018). Reasons for a resection surgery. Recovered from verywellhealth.com
4. Stanford health care (nd). Excisional and incisional biopsy. Recovered from stanfordhealthcare.org
5. Thaylor W, J (2016). Incisional & excisional biopsy. Recovered from oncolink.org
6. Minor surgery in primary care (2012). Techniques and procedures in minor surgery. Recovered from sietediasmedicos.com
7. Pickering, O (sf). Surgical Instruments. Recovered from surgsoc.org.au
8. Sánchez S, OL; González D, Y; Hernández D, C; Davila, E. (2014). Surgical instruments manual. Recovered from medisur.sld.cu