AIIMS doctors identify ‘Red Alert Zone’ to reduce risks in complex cancer surgery

New Delhi: Two high-risk anatomical zones have been identified by AIIMS doctors to help reduce bleeding and prevent injury to vital organs during complex cancer surgery in women.

Dr M D Ray, professor in the Department of Surgical Oncology at Dr BRA-IRCH, AIIMS Delhi, along with his team identified an area below the uterine vessels as the "Red Alert Zone" or "Ray's Zone", where the ureter, urinary bladder, pelvic nerves and important blood vessels lie in close proximity.

The concept emerged from a study of 255 radical or modified radical hysterectomies performed for cervical, endometrial and ovarian cancers.

After analysing the anatomy and causes of operative bleeding and injury, the surgical approach was modified in the later 105 cases.

The technique emphasises meticulous anatomical visualisation, magnification when required, individual vessel ligation and avoidance of excessive cautery near the pelvic ureter.

Researchers said careful dissection in Ray's Zone could help reduce blood loss and minimise ureteric, bladder and pelvic nerve injuries, thereby improving postoperative function and quality of life.

Dr Ray has also recently described another surgically important area, termed "Ray's Hepatocaval Triangle," relevant during liver mobilisation and dissection near the inferior vena cava and major hepatic venous structures.

The hepatocaval region is considered technically demanding because uncontrolled manipulation can result in major vascular injury and severe bleeding.

According to the surgical concept, defining this anatomical triangle provides surgeons with a clearer operative reference while handling the liver near major vessels.

Both anatomical concepts are based on a common principle -- identifying a potentially hazardous surgical area before entering it and performing controlled, anatomy-guided dissection.

The researchers said such anatomical mapping could improve surgical precision and help preserve vital structures during major oncological procedures.

In simple terms, Ray's Zone in the pelvis and Ray's Hepatocaval Triangle near the liver act as anatomical warning zones, reminding surgeons where maximum precision and caution are required.