Ongoing investigations

Short-term research shows that minimally invasive procedures may be as effective as traditional surgery in many cases. But the different techniques must still be compared in long-term studies.

For example, MIS enables surgeons to operate with more precision than with conventional techniques. And because surgeons can reach cancers or suspected cancers without making large incisions, minimally invasive procedures can have significant advantages over traditional surgery, including shorter recovery times, less bleeding and post-operative pain, and fewer complications.

But MIS can have drawbacks as well. Because most of these procedures are performed remotely using long instruments and imaging, doctors do not have direct contact with tissue during surgery. That may prevent them from examining tissue by touch and detecting abnormalities that may not be visible.

Minimally invasive surgery

Recent scientific advances are transforming the field of cancer surgery.

Minimally invasive surgery, or MIS, which is broadly defined as surgery requiring a smaller incision than a traditional, or open, procedure, is changing the landscape of cancer surgery. It’s becoming increasingly sophisticated as the result of breakthroughs in surgical technology, including the use of robotics and computer-assisted instruments.

While surgeons frequently use MIS to diagnose and evaluate difficult-to-reach tumors, minimally invasive techniques are also increasingly used to treat and remove some smaller tumors, including early stage lung, colon, and prostate cancers. In some cases, MIS may even allow oncologists to fully remove localized tumors that were previously extremely risky to treat with traditional surgery.

MIS can also help ease the symptoms of advanced cancer, relieving pressure caused by a tumor or removing tissues blocking the digestive or respiratory tracts.

New surgical approaches

Here are some of the most innovative developments in MIS that are available now. Others are still in the exploratory phase or being investigated in clinical trials:

Laparoscopy. In this procedure, surgeons insert a laparoscope — a flexible telescopic rod that's connected to a video camera or lens — through a small incision. This device enables oncologists to take biopsy samples and execute other surgical procedures in difficult-to-reach areas with smaller incisions, less blood loss, and faster recovery time.

Interventional Radiology. Considered one of the least invasive surgical techniques, oncologists use interventional radiology (IR) both to diagnose and treat cancer. Using imaging techniques such as X-ray, CT scan, MRI, or ultrasound, interventional radiologists are able to guide small catheters and other tools through tiny incisions. Doctors can then deliver treatments like high-dosage chemotherapy, radiation therapy, and heat or cold therapy directly to the tumor.

Interventional radiology techniques enable doctors to perform a variety of delicate procedures with exceptional accuracy and using smaller incisions. These include biopsies, implanting medical devices such as ports and catheters, chemoembolization, and stabilizing fractured bones.

Without interventional radiology, many of these procedures would require more extensive surgery, and some couldn't be performed at all. IR techniques can also reduce the risk and discomfort associated with surgery.

Electromagnetic Navigation Bronchoscopy. In traditional bronchoscopy, doctors insert a bronchoscope, or long, thin fiber optic camera, through the nose or mouth, into the deepest tissue of the lungs for diagnosis. Electromagnetic navigation bronchoscopy uses imaging to guide the bronchoscope and creates a 3D image of lesions in areas of the lungs that are otherwise inaccessible. This allows a much higher rate of accuracy in diagnosing cancer, without the risk of complications common to other kinds of tests.

Sentinel Node Biopsy. This procedure enables doctors to determine whether cancer has spread to the lymph nodes without having to surgically remove large numbers of nodes. Blue dye and a harmless radioactive tracer are injected near the tumor, from which they travel to the lymph nodes. The first lymph nodes that take up the dye and radioactive tracer are called the sentinel nodes, and the surgeon removes these for biopsy. If there is no cancer in the sentinel nodes, the other lymph nodes are most likely cancerfree as well. Sentinel node biopsy is used most frequently in the staging of breast cancer and melanoma.

Stereotactic Surgery. This procedure allows surgeons to locate, map, and remove tumors that are otherwise difficult to reach, using computer-assisted surgical tools and MRI or CT imaging technology. Stereotactic techniques can also be used in radiation, to deliver high dosages to very precise locations.