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Open vs keyhole surgery

Updated 20.06.2022
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Surgery falls into two broad categories: open surgery and minimally invasive surgery, also called laparoscopic surgery or keyhole surgery. Laparoscopic surgery has become the preferred option for many types of operations in recent decades, as it has some advantages over open surgery, but overall the outcomes of success for both procedures are similar.

What is open surgery?

Open surgery is a traditional method of surgery and is the most common. The doctor makes a large incision through the skin and tissues using a blade called a scalpel, and this creates a hole to get a full view and access to organs if they need to be repaired, removed or replaced. The incision is then closed with stitches and possibly staples. There are times when it is more advantageous to have open surgery, for example for emergency operations, complicated surgeries or those requiring access to large organs. An appendicectomy is a good example. Your appendix is usually removed as an emergency as it's inflamed and causing you illness and pain. it can be done as open or laparoscopic, but open surgery is more likely if you have developed a severe infection or the appendix has burst.

What is laparoscopic surgery?

Laparoscopic surgery uses a long thin tube called a laparoscope, which is inserted through a small incision, with a camera and light on the end to look inside the abdominal organs. Other small incisions may be made to accommodate small surgical instruments, or where air is pumped in to get a good view internally. Images on the end of the camera are sent to a monitor for the surgeon to see as the procedure progresses.

Why choose one over another?

There are many differences between open and laparoscopic surgery. Laparoscopic surgery makes much smaller incisions than open surgery, which speeds up recovery time. During the operation, there’s less blood loss and trauma, afterwards there’s less risk of infection, pain and problems with wound healing. Therefore patients are on their feet sooner, needing less painkillers and less time staying in hospital. There’s less of a scar, too. All of this makes it more favourable for most patients and surgeons, and is more likely for planned - or elective - operations. Open surgery is better for extensive surgery, for example in the abdomen, or in certain emergencies.

Are there any negatives of laparoscopic surgery?

Laparoscopic surgery requires more technology and so is more expensive, and therefore may only be available in certain specialist centres. It can also be difficult for more complex surgeries or ones requiring access to a large amount of the abdomen. Laparoscopy is also performed under general anaesthesia, where you are put to sleep, unlike open surgery, which can sometimes be done under local anaesthetic.

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