Minimally Invasive Cancer Surgery

Diagnostic Surgery for GI Cancer

Gastrointestinal (GI) cancer (cancers of the digestive tract: colon, esophagus, gallbladder, liver, intestine, pancreas, rectum, and stomach, is the third most common type of cancer in the U.S. Often, people aren’t diagnosed with a GI cancer until they have advanced disease, for which initial surgery is unsuccessful. Cooper aggressively treats advanced GI cancer. For example, doctors can use chemotherapy to shrink many advanced tumors. Surgeons use laparoscopy to accurately diagnose the tumor.

Laparoscopy can help prevent unnecessary surgery in patients with cancer that cannot be detected by CT scan or MRI. It also allows other treatments to be started promptly.

Using the results of the diagnostic laparoscopy, patients can make a rational decision about the best treatment plan and which treatment (e.g. surgery, chemotherapy, radiotherapy), or combination of treatments, is best. Diagnostic laparoscopy is often combined with standard imaging studies (e.g., ultrasound, CT scan and MRI) and staging surgery.

Once a cancer is suspected or diagnosed, the disease is staged, a process in which doctors attempt to find out how much, if any, of the cancer has spread from its original site. Accurate staging is crucial in determining the best treatment. Cooper surgeons use laparoscopy to identify cancers that can’t be detected using standard imaging studies such as ultrasound, CT scan, and MRI, preventing unnecessary surgery. It enables doctors to stage cancer more accurately and determine the best treatment for each patient.

Results from minimally invasive laparoscopy are available quickly for use in planning the patient’s care and starting treatment promptly. Staging procedures to evaluate the extent of the tumor are often done at the same time as diagnostic surgery. The results of the staging surgery help in planning the best treatment and in choosing which treatment (e.g. surgery, chemotherapy, radiotherapy), or combination of treatments, is best.

Curative Surgery for Cancer
Curative surgery is done to remove a tumor or growth when it appears to be confined to one area. The goal of curative surgery is to remove all of the cancer. Since curing cancer is the goal, minimally invasive surgery is not appropriate for all tumors. When minimally invasive surgery is appropriate, laparoscopy is often used.

Sentinel Lymph Node Biopsy for Breast Cancer
Breast cancer is the most common cancer in American women. Two thirds of all cases of breast cancer are “early cancers” that have not spread outside the breast; the cure rate for this type of breast cancer is high.

When breast cancer does spread, it usually spreads to the axillary lymph nodes. The presence or absence of lymph node involvement is the best predictor of outcome, and of the need for chemotherapy. Because physical exams and x-rays do not reliably predict whether the lymph nodes are involved, this has traditionally been determined by surgical removal of most of the lymph glands under the armpit, and analysis of the tissue by a pathologist.

However, this surgery causes pain and swelling (lymphedema) of the arm, and may be unnecessary because in early-stage breast cancers, there is often no cancer in the lymph glands. A minimally invasive technique, sentinel node biopsy, allows analysis of the lymph nodes that have the greatest risk for spread, known as the sentinel nodes. This minimizes the extent of surgery, resulting in a faster recovery and less time in the hospital. Sentinel node biopsy has been shown to be more accurate in assessing breast cancer than surgical removal of most of the lymph glands under the armpit.

Palliative Surgery for Cancer
When the cancer is too advanced to be removed, surgery is sometimes done to relieve symptoms such as intestinal obstruction (which can cause vomiting or bloating), bleeding, or the inability to eat enough. Often, these procedures can dramatically improve the patient’s quality of life and allow other treatments (e.g., chemotherapy, immunotherapy, or radiotherapy) to be given.

Laparoscopic Procedures To Evaluate the Nature and Source of Tumors:

Diagnostic Laparoscopy for Evaluation
Certain medical problems in the abdomen or pelvis cannot be fully diagnosed through physical examination, x-rays, or other imaging tests. Cooper surgeons use diagnostic laparoscopy to look directly at the structures of the body within the abdomen and pelvis and determine if the problem is cancer. When cancer is diagnosed, diagnostic laparoscopy allows Cooper surgeons to assess the tumor quickly to make a precise diagnosis.

Laparoscopic Biopsy of Intraabdominal Masses
Although a lump (mass or tumor) in the abdomen can sometimes be felt or identified by a diagnostic test like a CT scan, MRI, or ultrasound, in most cases, a definitive diagnosis of cancer is necessary before appropriate therapy or treatment can be recommended. Cooper surgeons can use laparoscopy to perform a biopsy and make a definitive diagnosis.

Laparoscopic Biopsy of Intraabdominal and Retroperitoneal Lymph Nodes
For patients with urological or gynecological cancer (e.g., testicular, ovarian, cervical, or endometrial cancer) or suspected lymph node cancer (lymphoma), intraabdominal and retroperitoneal lymph nodes must be examined to determine whether cancer has spread outside the primary location. The traditional “open” surgery to dissect the retroperitoneal lymph nodes is a major operation involving an incision from the breast bone (sternum) to the pubic bone. Cooper surgeons use laparoscopy to perform a biopsy and determine whether the cancer has spread.

Staging Procedures to Evaluate the Extent of Tumors:

Laparoscopy for Staging
Although a lump (mass or tumor) in the abdomen can sometimes be felt or identified by a diagnostic test like a CT scan, MRI, or ultrasound, in most cases, a definitive diagnosis of cancer is necessary before appropriate therapy or treatment can be recommended. Cooper surgeons can use laparoscopy to perform a biopsy and make a definitive diagnosis. If the diagnosis is cancer, laparoscopy can be used to stage it. Additional tests may be needed to completely define the stage of disease.

Laparoscopic Evaluation and Biopsy of Intraabdominal Masses
Although a lump (mass or tumor) in the abdomen can sometimes be felt or identified by a diagnostic test like a CT scan, MRI, or ultrasound, in most cases, a definitive diagnosis of cancer is necessary before appropriate therapy or treatment can be recommended. Cooper surgeons can use laparoscopy to evaluate and biopsy the mass and make a definitive diagnosis.

Laparoscopic Evaluation and Biopsy of Intraabdominal and Retroperitoneal Lymph Nodes
For patients with urological or gynecological cancer (e.g., testicular, ovarian, cervical, or endometrial cancer) or suspected lymph node cancer (lymphoma), intraabdominal and retroperitoneal lymph nodes must be examined to determine whether cancer has spread outside the primary location. The traditional “open” surgery to dissect the retroperitoneal lymph nodes is a major operation involving an incision from the breast bone (sternum) to the pubic bone. Cooper surgeons use laparoscopy to perform a biopsy and determine whether the cancer has spread.

Evaluation Procedures for Breast Abnormalities:

Ultrasound for Breast Lesion Evaluation
Ultrasound is a radiological study that can now be performed by our Breast Surgeons in the office. The ultrasound allows for a better, faster and a more complete evaluation of abnormalities that are found within the breasts. Patients can now have the study completed in the office without having to make an additional appointment with a radiology department. It has become the “Gold Standard” for breast surgeons.

Mammotome for Breast Lesion Biopsy and Removal
A mammotome is a machine that allows the breast surgeon to complete biopsies and removal of lesions in a patient’s breast. The procedure is minimally invasive and is performed with local anesthesia. The entire procedure is done through a small incision that is less than ONE centimeter. Patients need not go to the operating room and the majority of patients don’t require pain medications afterwards. The biopsy procedure usually takes less than an hour, and patients can often return to their normal daily activities immediately.

Mammosite Breast Cancer Treatment
Mammosite is a new type of targeted radiation therapy. The radiation is more concentrated, the treatments are shorter in duration, and the side effects are milder as compared to traditional external beam radiation therapy. With the mammosite technique, radiation is directed to the area immediately surrounding your lumpectomy, so that healthy tissue is spared from the side effects of the therapy. The applications take only five days as compared to 6-7 weeks for conventional radiation. Side effects may include redness, bruising and breast pain in some patients. Other patients experience no side effects at all.

During targeted mammosite radiation therapy, a tiny, soft balloon is place inside the lumpectomy cavity with a small tube attached. Most women feel little or no discomfort during this procedure, which is preformed under local anesthesia. A tiny ‘seed’ of radiation is placed inside the balloon through the small tube. The session lasts about 30 minutes and your radiation oncologist will treat you twice a day. No radioactive material remains inside your body after the session is complete.

A small portion of the tube will remain outside your breast during the five days of treatment to assist in the delivery of each of your 10 seeds. You can resume normal activities after each of your doctor visits. The balloon and tube are gently removed after the last treatment. The small incision is closed with Steristrips. Most women feel little or no discomfort during removal.

Anorectal Evaluation Procedures:

Ultrasound and Manometry for Anal-Rectal Evaluation
Ultrasound and Manometry studies can now be performed by our Colorectal Surgeons in their office. These studies allow for a better, faster and a more complete evaluation of abnormalities that are found within the rectum (including depth of invasion) and assessment of anal sphincter function. Patients can now have the studies completed in the office without having to make additional appointments.

To Remove GI Tumors:

Laparoscopic-Assisted Colon Resection for Colon Polyps / Precancerous Lesions and Cancer
With traditional surgery, removing part of the colon is a major operation. Cooper surgeons often use laparoscopy or robotic assisted laparoscopy to do the same operation through many tiny incisions.

Laparoscopic Splenectomy
Patients with certain blood disorders may need to have their spleen removed (splenectomy). Cooper surgeons routinely use laparoscopy to remove the spleen.

Laparoscopic-Assisted Partial Gastrectomy
Removal of part of the stomach, often with removal of surrounding lymph nodes, is the only curative treatment for stomach cancer. Cooper surgeons use laparoscopy to remove part of the stomach and attach the rest of the stomach to the small intestine.

Laparoscopic Excision of Intraabdominal Masses
Cooper surgeons can use laparoscopy to remove a small cancerous tumor in the abdomen.

For Prostate and Kidney Tumors:

Laparoscopic Lymph Node Removal
This procedure is used to determine if prostate cancer has spread (metastasized) to the lymph nodes in the pelvis. Patients with a significantly elevated prostate-specific antigen (PSA) blood test, a high tumor grading (Gleason score), and/or disease on both sides of the prostate (bilateral) are more likely to have cancer that has spread to the pelvic lymph nodes. Since treatment options are different for patients with metastatic prostate cancer, determining if the cancer has reached the pelvic lymph nodes before surgery or radiation therapy is very important. Cooper surgeons use laparoscopy to take a sample of the lymph nodes for analysis.

Laparoscopic Nephrectomy
Kidney removal (nephrectomy) may be necessary in patients with kidney cancer. Cooper surgeons use laparoscopy or robotic assisted laparoscopy (the daVinci® Surgical System) to remove a kidney. Laparoscopy enables surgeons to see the kidney better during surgery and results in a much smaller scar—about 3”—than traditional surgery, which requires a 10-20” scar and the removal of a rib.

Laparoscopic Partial Nephrectomy
When kidney cancer is diagnosed before it has spread to other parts of the body and the tumor is small, or the patient has other medical conditions affecting kidney function, it may be possible to only remove part of the kidney (partial nephrectomy). The technique for partial nephrectomy is similar to complete removal of the kidney; however, additional reconstruction is needed to repair the damaged tissue and to restore kidney function. Cooper surgeons use laparoscopy or robotic assisted laparoscopy (the daVinci® Surgical System) to remove a kidney. Laparoscopy enables surgeons to see the kidneys better during surgery and results in a much smaller scar—about 3”—than traditional surgery, which requires a 10-20” scar and the removal of a rib.

Laparoscopic Nephroureterectomy
Transitional cell carcinoma is a type of cancer that can occur in the renal pelvis and/or ureter. Surgical removal of the kidney and the ureter (nephroureterectomy) may be necessary if cancer has formed in the lining of these structures, if there is a long history of reflux within the kidney, or if the kidney is non-functioning. Cooper surgeons use laparoscopy to remove the kidney and ureter, resulting in a much smaller scar—about 3”—than traditional surgery, which requires an incision from the abdomen to the pelvis.

For Colon Tumors:

Colon Surgery
With traditional surgery, removing part of the colon is a major operation. Laparoscopy, in which surgeons do the same operation through many tiny incisions, is becoming more common for certain colon cancers.

For Gynecological Tumors:

Laparoscopic-Assisted Vaginal Hysterectomy
Endometrial cancer, the most common gynecologic cancer, affects the endometrial lining of the uterus. Surgical removal of the uterus (hysterectomy) may sometimes be necessary to treat endometrial and other cancers. In some cases, the ovaries and the fallopian tubes must be removed too. Cooper surgeons use laparoscopic-assisted vaginal hysterectomy to remove the uterus, and, if necessary, the ovaries and fallopian tubes, through the vagina instead of through an incision in the abdomen.

Laparoscopic Oophorectomy or Salpingo-oophorectomy
Surgical removal of the ovaries (oophorectomy) or the ovaries and the fallopian tubes (salpingo-oophorectomy) may be necessary to treat ovarian tumors and other conditions. Cooper surgeons use laparoscopy to remove the ovaries and fallopian tubes.

Endocopic Procedures To Remove Tumors in the Head and Neck:

Endoscopic Laryngeal Surgery
Cancerous and non-cancerous tumors can affect the larynx. Surgery is often used to remove tumors in the larynx. Cooper surgeons use endoscopy and lasers to remove early-stage tumors in the larynx without incisions.

Robotic Procedures For Kidney Tumors:

Robotic Radical Nephrectomy
Kidney removal (radical nephrectomy) may be necessary in patients with kidney cancer. Cooper surgeons can use robotic assisted laparoscopy (the daVinci® Surgical System) to remove a kidney. Robotic-assisted laparoscopy is done through three small incisions, compared to a 10-20” incision and removal of a rib with a traditional radical nephrectomy.

Robotic Partial Nephrectomy
Kidney cancer is often diagnosed early, before it has spread to other parts of the body. When the tumor is small or the patient has other medical conditions affecting kidney function, it may be possible to remove only part of the kidney (partial nephrectomy). The technique for partial nephrectomy is similar to complete removal of the kidney; however, additional reconstruction is needed to repair the damaged tissue and to restore kidney function.

Cooper surgeons can use robotic assisted laparoscopy (the daVinci® Surgical System) to remove part of a kidney. Robotic-assisted laparoscopy is done through three small incisions, compared to a 10-20” incision and removal of a rib with traditional partial nephrectomy.

Cooper University Hospital is one of only a handful of medical centers in New Jersey and one of only a few in the Delaware Valley using the daVinci® Robotic System to treat prostate cancer and kidney cancer. For more information about the daVinci® robot, please visit Intuitive Surgical, Inc.

Radiosurgery

Video-Assisted Thorascopy for Lung Cancer
Video-assisted thorascopy is used to biopsy and evaluate lung cancer, and to remove lung tumors and rebuild the lungs and surrounding tissue.

Sentinel Lymph Node Biopsies

Sentinel Lymph Node Biopsy for Breast Cancer
When breast cancer spreads, it usually spreads to the axillary lymph nodes. Within the lymph nodes, the sentinel nodes are where the cancer is most likely to spread. Sentinel node biopsy is a minimally invasive technique that allows analysis of the sentinel node. The sentinel node (the first lymph node draining a cancer) is identified during surgery after the injection of a radiolabeled tracer (technetium-99m labeled sulfer colloid) and colored dye (isosulfan blue) around the cancer. Sentinel node biopsy is often done as an outpatient procedure. It is very successful in identifying the sentinel node and allows precise evaluation of the axillary lymph gland.

Sentinel Lymph Node Biopsy for Melanoma
Within the lymph nodes, the sentinel nodes are where the cancer is most likely to spread. Sentinel node biopsy is a minimally invasive technique that allows analysis of the sentinel node. The sentinel node (the first lymph node draining a cancer) is identified during surgery after the injection of a radiolabeled tracer (technetium-99m labeled sulfer colloid) and colored dye (isosulfan blue) around the cancer. Sentinel node biopsy is often done as an outpatient procedure. It is very successful in identifying the sentinel node and allows precise evaluation of the axillary lymph gland.

Laparoscopic Procedures For GI Cancer Pain:

Laparoscopic Cholecystojejunostomy
In cholecystojejunostomy, the pancreas is bypassed and the gallbladder is connected directly to the small intestine to relieve a painful blockage due to pancreatic cancer. Cooper surgeons can use laparoscopy to perform this procedure.

Laparoscopic-Assisted Colon Resection
Cooper surgeons use laparoscopy to remove all or part of the colon adjacent to the small intestine, This procedure, called resection (colectomy), is used to remove tumors.

Laparoscopic Colostomy
When colon cancer is treated with surgery, the surgeon may create an artificial way for stool to drain out of the colon through an opening in the abdomen called a colostomy. Cooper surgeons can use laparoscopy to perform this procedure.