Why the approach matters. How decisions are made. What patients should know.
When surgery is advised for a gynaecological condition, one of the most common questions patients ask is:
“Will this be done by laparoscopy or open surgery?”
Understanding the difference between these two approaches helps reduce anxiety, clears misconceptions, and allows patients to participate meaningfully in decision-making. It is important to remember that the best surgical approach is the one that is safest and most appropriate for the individual patient, not necessarily the newest or most advertised
WHAT IS OPEN (CONVENTIONAL) SURGERY?
Open surgery is the traditional surgical method in which the operation is performed through a larger abdominal incision. This approach has been used safely for decades and is still required in certain situations.
Characteristics of open surgery:
- Larger incision on the abdomen
- Direct visual and manual access to organs
- Longer hospital stay
- Slower recovery compared to minimally invasive techniques
Open surgery is a reliable and time-tested approach, especially in complex or emergency situations.
WHAT IS LAPAROSCOPIC (KEYHOLE) SURGERY?
Laparoscopic surgery is a form of minimally invasive surgery performed through small incisions (usually 0.5–1 cm) using a camera and specialised instruments.
A high-definition camera provides a magnified view of internal organs, allowing precise surgical work with minimal tissue disruption.
Common laparoscopic procedures include:
- Laparoscopic hysterectomy
- Fibroid (myomectomy) surgery
- Ovarian cyst removal
- Endometriosis surgery
- Diagnostic laparoscopy
KEY DIFFERENCES BETWEEN LAPAROSCOPY AND OPEN SURGERY
Incisions and Scarring
- Open surgery: Larger incision, visible scar
- Laparoscopy: Small incisions, minimal scarring
Post-Operative Pain
- Open surgery usually involves more pain
- Laparoscopy generally results in less discomfort
Hospital Stay
- Open surgery often requires a longer stay
- Laparoscopic surgery typically allows discharge within 24–48 hours
Recovery Time
- Recovery after open surgery may take several weeks
- Recovery after laparoscopy is usually faster
Blood Loss
- Blood loss is generally higher in open surgery
- Laparoscopy often involves minimal blood loss
IS LAPAROSCOPY ALWAYS BETTER?
No.
While laparoscopy offers many advantages, it is not suitable for every patient or every condition. The idea that all surgeries should be done laparoscopically is a misconception.
Laparoscopy works best when:
- The condition is suitable for minimally invasive access
- The procedure can be performed safely without compromising outcomes
- The surgeon has adequate training and experience
Safety always takes precedence over approach.
WHEN IS OPEN SURGERY PREFERRED?
Open surgery may be recommended in situations such as:
- Very large or complex masses
- Extensive scarring from previous surgeries
- Severe infections or emergencies
- When visibility or access is limited laparoscopically
- When patient safety could be compromised with minimally invasive methods
Recommending open surgery does not mean outdated care — it means appropriate care.
HOW DOES THE SURGEON DECIDE WHICH APPROACH IS BEST?
The choice between laparoscopy and open surgery depends on multiple factors, including:
- Nature and size of the condition
- Previous surgeries
- Overall health of the patient
- Surgeon’s assessment of safety
- Availability of appropriate facilities
Each decision is individualised and discussed with the patient.
ROLE OF SURGEON EXPERIENCE
The success of any surgery depends more on surgeon training and judgment than on the surgical approach alone.
A well-performed open surgery is always better than a poorly selected laparoscopic procedure. Conversely, when laparoscopy is performed by an experienced surgeon in appropriate cases, outcomes are excellent.
Patients should feel comfortable asking:
- Why a particular approach is recommended
- What alternatives exist
- What recovery will involve
Clear communication is a key part of ethical care.
RECOVERY & AFTERCARE: WHAT PATIENTS SHOULD EXPECT
After Laparoscopic Surgery:
- Early mobilisation
- Less need for pain medication
- Faster return to daily activities
- Smaller scars
After Open Surgery:
- Longer rest period
- Gradual return to activities
- More intensive wound care
- Slower overall recovery
Both approaches require proper follow-up and adherence to medical advice.
COMMON MYTHS ABOUT SURGICAL APPROACHES
Myth: Laparoscopy is always safer
Fact: Safety depends on correct case selection
Myth: Open surgery means poor quality care
Fact: Open surgery remains essential in many cases
Myth: Bigger surgery means better treatment
Fact: The goal is effective treatment with the least harm Understanding these differences helps set realistic expectations.
FREQUENTLY ASKED QUESTIONS
Will I always be offered laparoscopy if surgery is needed?
Only if it is safe and appropriate for your condition.
Is recovery always quick after laparoscopy?
Most patients recover faster, but individual response varies.
Can open surgery be converted from laparoscopy?
Yes. Conversion is sometimes done to ensure safety.
Should patients insist on laparoscopy?
Patients should seek explanation, not insist on a method.
A BALANCED FINAL NOTE
The decision between laparoscopy and open surgery is not about choosing “modern” versus “traditional” — it is about choosing what is safest and most effective.
A thoughtful surgical recommendation considers:
- Patient safety
- Long-term outcomes
- Surgical expertise
- Individual clinical factors
If surgery has been advised, discussing the approach openly allows confidence and clarity.