What Is a Surgical Excision?

Excision means "to surgically remove." In medicine, the term indicates the removal of a growth, tissue, organ, or bone using a scalpel, laser, or another cutting tool.

As opposed to taking a sample of tissue or a body part, excision describes the removal of the entire portion of a structure. For instance, a lumpectomy is an excisional biopsy that removes an entire breast tumor. This is different than a core biopsy, which takes just a part of the lump.

Surgeries used to remove a specific part of the body often end with the suffix "-ectomy." An appendectomy (used to remove the appendix) and cholecystectomy (gallbladder removal) are two such examples.

This article describes 10 different excisional procedures used to diagnose or treat medical conditions. It also lists the different healthcare providers who routinely perform excisional surgeries.

Why Excisions Are Done

Surgical excision is often used with the intent to cure a condition. Even so, additional treatments—called adjuvant therapies—may be prescribed after surgery to prevent a disease from coming back.

For example, a person may undergo adjuvant radiation therapy after a tumor has been removed to ensure that all remaining cancer cells are killed.

On the other hand, neoadjuvant therapy may be used before surgery to make it less invasive and more effective. For instance, neoadjuvant chemotherapy may be prescribed before surgery to shrink a tumor and make it easy to remove without complications.

Who Performs Surgical Excisions?

Surgical excisions are typically performed by surgeons, some of whom are general surgeons who can perform procedures like appendectomies and cholecystectomies. Others are specially trained and certified to treat specific organ systems.

Examples of specialists who perform excisions include:

• Neurosurgeons, who treat diseases of the brain and central nervous system
• Surgical oncologists, who treat cancer
• Orthopedic surgeons, who specialize in bone and joint disorders
• Cardiothoracic surgeons, who treat diseases of the heart, lungs, esophagus, and other organs in the chest

Excisions may be performed in a hospital or on an outpatient basis in an office, clinic, or surgical center.

10 Examples of Excisional Surgeries

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

Some excisions are performed as traditional open surgeries involving a scalpel and a large incision. Others are performed laparoscopically, meaning with specialized tools that are manipulated through smaller incisions.

Local, regional, or general anesthesia, or no anesthesia at all, may be used, depending on the procedure.

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 melanoma.

Also known as a wide local incision, excisional skin biopsy involves the removal of a tumor and some normal tissue around it (called the clinical margin). The size of the margin depends on the thickness of the tumor.

In some cases, skin grafting or a skin flap is used to cover the wound. Other wounds are simply closed with stitches.

Tumor Craniotomy With Excision

This surgery involves the removal of a section of bone from the skull (craniotomy) to access the brain so that a tumor can be taken out. The tumor can be benign (non-cancerous) or malignant (cancerous).

Almost all tumor craniotomies are performed with a computerized navigation technique known as stereotaxy. This improves the accuracy of the surgery and reduces the size of the incision needed to perform the excision.

The removal of the tumor involves specialized scalpels and scissors, a suctioning device called an ultrasonic aspirator, and special microscopes.

Myxoma Excision

This is the surgical removal of a benign heart tumor called a myxoma, which is typically found in the upper-left chamber of the heart. Myxomas account for roughly 50% of all heart tumors.

Surgical excision is the only form of treatment for myxomas. Because myomas are very fragile and vulnerable to rupture, their removal usually requires open surgery to provide clearer access to the chambers of the heart.

Excision of Venous Malformations

This is one of two treatment approaches used to remove venous malformations. These are caused by lesions in blood vessels that are present at birth but can grow over time to cause painful, hardened blood clots called phleboliths.

The surgical treatment of venous malformation involves the removal of abnormal veins as well as some of the tissues surrounding them.

Sclerotherapy, the other treatment approach, involves the injection of chemicals into veins to make them shrink. It is often used beforehand to reduce bleeding and make the malformation easier to remove.

Excision of Bone Tumors

This surgical procedure is used not only to remove malignant bone tumors but also benign tumors that can become malignant. Removing the tumor helps reduce the risk of a bone fracture.

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

A metallic plate or transplanted bone may be used to stabilize and strengthen the bone.

Functional Endoscopic Sinus Surgery With Polypectomy

The minimally invasive procedure is used to locate and remove a soft benign growth, called a polyp, from a nasal passage. It is used when conservative treatments like nasal steroids fail to provide relief.

The procedure is typically performed under general anesthesia with a rigid scope, called an endoscope. Once the polyp is located, it is quickly removed with forceps, cutting tools, or a cylindrical shaver called a microdebrider.

Colonoscopy With Polypectomy

This is a common procedure performed during an endoscopic examination of the colon (called a colonoscopy). As a precaution, any polyps found are removed on the off-chance they may turn cancerous.

The procedure is usually performed under monitored anesthesia care (MAC) which causes "twilight sleep."

If a larger polyp is located, a tool on the scope can pinch it off so that it can be sent to the lab for evaluation. Smaller ones may be removed as well, though some may instead be marked with tattoo ink so that they can be easily identified and looked at again during future colonoscopies.

Endometrial Excision

This is the complete removal of uterine tissues that have grown outside of the womb in people with endometriosis.

Robot-assisted laparoscopic surgery is commonly used for endometrial excision. This involves the insertion of specialized instruments through tiny keyhole incisions in the skin. The tools are manipulated outside of the body with master controls. Any excess tissue is then destroyed with intense heat (referred to as fulguration).

Orchiectomy

Orchiectomy is the surgical removal of one or both testicles. It is mainly used to treat testicular cancer or advanced prostate cancer.

Orchiectomy starts with an incision just above the pubic area. The testicle, spermatic cord, and tumor are then removed from the scrotum and extracted through the opening.

The operation can be performed either laparoscopically or as open surgery.

Acromioclavicular Joint Excision

This is a surgery used to remove a damaged acromioclavicular joint (ACJ) located where the clavicle (collarbone) and scapula (shoulder blade) meet. The aim is to do so without destabilizing the shoulder itself.

The surgery is typically used when the joint is severely damaged by arthritis or an injury. Using a specialized scope (called an arthroscope) and laparoscopic tools, the surgeon shaves and smoothes worn surfaces of the joint before cutting and removing a piece of the collarbone.

The joint will remain stabilized by ligaments that bridge the severed section of bone.

Summary

Excision is the removal of a growth, tissue, organ, or bone with a cutting instrument like a scalpel or laser. It indicates the removal of the entire growth or body part, either to diagnose or treat a medical condition (sometimes both).

Excisions are typically performed by surgeons either on an outpatient or inpatient basis.

There are many different types of surgical excisions used for a variety of reasons, from treating cancerous and benign tumors to endometriosis, damaged organs, and other conditions. Some may be performed with open surgery, while others may involve a less invasive procedure.

A Word From Verywell

The word excision may seem serious, but it's not necessarily so. The removal of a mole for cosmetic purposes is also a form of excision. In the end, an excision only indicates that a part of your body is being removed surgically.

If you are to undergo any surgical excision, ask your doctor why it is needed, what is involved, what the risks are, and if there are other less invasive options that may be just as effective. In the end, you are not questioning your doctor's judgment; you are simply obtaining all the information you need to make an informed choice.