Open vs keyhole 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, which 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 in appendicitis 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.

Here's a description of laparoscopic surgery:

1. Small incisions. Instead of making a large incision, the surgeon makes several small incisions (typically 0.5 to 1.5 centimeters in length) in the abdomen. These tiny incisions serve as entry points for the surgical instruments and the laparoscope.

2. Insertion of laparoscope. A laparoscope, which is a long, thin tube equipped with a high-resolution camera and light source, is inserted through one of the incisions. The camera provides a magnified, high-definition view of the internal organs on a monitor in the operating room, allowing the surgeon to visualize the surgical area in detail.

3. Surgical instruments. Additional specialized instruments, such as graspers, scissors, dissectors, and cautery devices, are inserted through the other incisions. These instruments are manipulated by the surgeon to perform the surgical procedure with precision and accuracy.

4. Procedure. Using the images from the laparoscope as a guide, the surgeon performs the surgical procedure. The instruments are used to manipulate tissues, remove diseased or damaged organs, repair defects, or perform other necessary interventions.

5. Closure. After completing the procedure, the instruments are removed, and the small incisions are closed with sutures or surgical tape. Because the incisions are small, they typically require fewer sutures and heal more quickly than traditional open surgery incisions.

Laparoscopic surgery offers several advantages over traditional open surgery, including:

• Reduced trauma. Smaller incisions result in less trauma to the surrounding tissues, leading to less pain, bleeding, and scarring.
• Faster recovery. Patients undergoing laparoscopic surgery often experience shorter hospital stays, faster recovery times, and earlier return to normal activities compared to open surgery.
• Improved cosmetic outcome. The small incisions used in laparoscopic surgery result in less visible scars, providing a better cosmetic outcome for patients.

Laparoscopic surgery is used to perform a wide range of abdominal and pelvic procedures, including cholecystectomy (gallbladder removal), appendectomy, hernia repair, gastric bypass surgery, hysterectomy, and colorectal surgery, among others. Arthroscopic surgery is a type of keyhole surgery. However, not all surgeries are suitable for the laparoscopic approach, and the decision to perform laparoscopic surgery depends on various factors, including the patient's medical history, the complexity of the procedure, and the surgeon's expertise.

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. Afterward, 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 the hospital. There's less of a scar, too. All of this makes it more favorable 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 certain emergencies.

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