Surgical Techniques
Fred Hutch surgeons use the full range of surgical techniques to remove cancer, and they have access to state-of-the-art medical technology for their surgeries.
Minimally Invasive Surgery
Minimally invasive surgery, such as laparoscopic surgery, is done through small incisions (cuts) in the abdomen. Endoscopic surgery is another type of minimally invasive surgery, done through a natural body opening, such as the mouth, nose or anus.
Minimally invasive surgical techniques result in less pain, less scarring, less blood loss (and need for blood transfusions), shorter hospital stays and faster recoveries for many patients compared to traditional open surgeries.
Laparoscopic Surgery
Laparoscopic surgery (laparoscopy) is done through several small incisions (cuts) in the abdomen. Through one incision, the surgeon inflates the abdomen with carbon dioxide gas, which creates space in the body to see and operate. Then, the surgeon uses other small incisions to put a laparoscope — a thin, lighted tube with a tiny video camera — and other surgical tools into the abdominal space. When this same technique is used for surgery on the chest, it is called thoracoscopic surgery.
Endoscopic Surgery
Endoscopic surgery (endoscopy) is similar to laparoscopic or thoracoscopic surgery, because very tiny surgical tools and scopes are used. However, the difference is that the scope goes in through one of the body’s natural openings, such as the mouth, nose or anus, not through incisions (cuts). Endoscopy can be used to remove some types of tumors in the throat, larynx, esophagus, colon, bladder, brain and other areas.
Video-Assisted Thoracic Surgery (VATS)
Video-assisted thoracic surgery (VATS) is a minimally invasive technique for patients who might otherwise need open-chest surgery (thoracotomy) to remove lung tissue. VATS is done using a small video camera called a thoracoscope, which is put into the chest cavity through a series of small incisions (cuts).
Open Surgery
Open surgery is the traditional form of cancer surgery. During open surgery, a surgeon makes one larger incision (cut) to access a tumor and diagnose, stage or treat cancer.
Fred Hutch doctors always consider minimally invasive treatment options for their patients. However, in some complex cases, open surgery is a better choice. Other times, it is simply not possible to use a minimally invasive approach. For example, sometimes the size or location of a tumor makes it impossible to remove with a minimally invasive procedure.
Examples of open surgeries are laparotomy, which is an abdominal surgery, and thoracotomy, which is an open surgery of the chest. Maxillofacial surgeries (surgeries of the face, jaw or mouth) are sometimes done as open surgeries as well.
Laser Surgery
Laser surgery is a minimally invasive technique where a laser is used to cut through tissue or vaporize (burn) cancers, destroying the cells. A carbon dioxide laser makes a beam of infrared light, which can ablate tumors or cells that have gone through precancerous changes.
Fred Hutch gynecologic oncologists use laser surgery to treat some female reproductive system cancers. Our head and neck surgeons also use it to ablate precancerous lesions and early cancers in the mouth and throat and to remove certain cancers in the larynx. Using laser surgery in this way is often better than traditional surgery and results in better outcomes for a patient’s swallowing and voice.
Radiofrequency Ablation (RFA)
Radiofrequency ablation (RFA) is when heat is used to kill cancer cells. It is especially useful in treating cancers that are difficult to remove with surgery.
To do RFA, a surgeon puts a needle-like probe into the tumor. An ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) is used to guide the probe to the right place. Next, an electrical current is sent through the probe, creating heat around the end of the probe to destroy the cancer cells. The probe can be passed through the skin into the tumor (called percutaneous RFA, which is done by an interventional radiologist), or it can be put into a tumor by a surgeon during open, laparoscopic or thoracoscopic surgery. Often, RFA is used to treat liver tumors and some lung tumors.
Irreversible Electroporation (NanoKnife)
Irreversible electroporation (IRE) uses electrical currents to open the membrane around a cancer cell and destroy it without harming the surrounding healthy tissue.
During the procedure, needle-like NanoKnife® probes are put into the tumor. A computed tomography (CT) scan or magnetic resonance imaging (MRI) is used to guide the probe to the right place. Then, micropulses of electricity are sent through the probes, causing the cell membranes to open and be destroyed. The probes can be passed through the skin, or they can be put into a tumor during surgery.
IRE is often used to treat liver tumors that are close to other vital organs and structures that cannot be removed surgically or safely destroyed using radiofrequency ablation (RFA).
Argon Beam Coagulation
Gynecologic oncologists use an argon beam coagulator to treat ovarian cancer. This device uses electrical current passed through a stream of argon gas to help with cytoreductive surgery (CRS), which is used to reduce the size of the tumor. It is used as an adjunct therapy to achieve the goal of CRS, which is to destroy all visible disease.
Robot-Assisted Surgery
For robot-assisted surgeries, our surgeons use the da Vinci Surgical System. With this system, the surgeon sits at a computer console near the patient and uses the attached devices to control three robotic arms. One robotic arm holds a camera, and the others hold surgical tools. This system gives the surgeon a 3D view of the treatment area, allowing them to do very precise, complex motions.
Robot-assisted surgery can be used to treat a wide range of cancers, such as bladder, colorectal, endometrial, kidney, liver, lung, ovarian, pancreatic, penile, prostate, throat, thyroid and tongue cancers.
Fred Hutch doctors also have access to a dual-console da Vinci robot, which allows two surgeons to do complex robot-assisted surgeries at the same time.
Hysterectomy
Through tiny incisions (cuts), our surgeons do robot-assisted hysterectomies for patients with endometrial or uterine cancer. Using this system, they are able to remove the uterus with great precision and control.
Nephrectomies for Renal Cell Carcinoma
A surgeon can remove part or all of a kidney through small incisions (cuts) and using robotic technology, depending on where the cancer is and how much needs to be removed.
Robot-Assisted Surgery for Liver, Bile Duct and Pancreatic Cancer
Liver, bile duct and pancreatic cancer surgeries are complex and can also be treated using robotic technology. The 3D visualization and the improved precision and control of the robot allow these complex surgeries to be done as minimally invasive procedures.
Prostatectomy for Prostate Cancer
Surgeons at Fred Hutch can use laparoscopic prostatectomy to remove prostate glands using tiny surgical tools and several small incisions (cuts). This procedure has mostly replaced traditional open prostatectomy, when a surgeon operates through a single larger incision to remove the prostate and the lymphatic tissues, which can contain cancer.
Transoral Endoscopic Surgery for Throat Cancer
Using a tiny surgical camera and microscope that are passed through the mouth, our surgeons can treat throat cancers, avoiding the need for other surgeries or tracheotomy. This approach may also minimize or eliminate the need for chemotherapy and radiation as additional treatments.
Transaxillary Hemithyroidectomy for Thyroid Cancer
In this procedure, half of the thyroid is removed through an incision (cut) in the underarm (axilla) area, instead of the neck. This procedure is sometimes preferred because the scar is hidden in the underarm and, with proper care, the incision can heal faster than a neck incision. Surgeons are able to see a very detailed view of the treatment area with this approach.