Patients are often told they need “keyhole surgery”, then hear the words laparoscopic, robotic and minimally invasive used as if they meant the same thing. They overlap, and the differences matter when you are deciding about an operation.
Open surgery
In open surgery the operation is carried out through a single incision large enough for the surgeon’s hands, usually across the lower abdomen and typically 10 to 15 centimetres long, or sometimes up and down the middle. Open surgery remains the right choice for some operations, but recovery is usually slower and the hospital stay longer.
Keyhole surgery
Keyhole surgery is the everyday name for surgery carried out through several small incisions, usually between 5 and 12 millimetres, rather than one large one. A slim camera shows the inside of the abdomen on a screen, and fine instruments pass through the other incisions. The abdomen is gently inflated with carbon dioxide gas to give room to work.
“Minimally invasive surgery” is the medical term for the same idea: reaching the operation through the smallest possible openings. It is where the MI in MIGynaecology comes from.
There are two forms of keyhole surgery.
Laparoscopic surgery
In laparoscopic surgery the surgeon holds and moves the camera and instruments directly, watching the screen. It is well established and used for a wide range of gynaecological operations.
Robotic surgery
In robotic surgery, the surgeon sits at a console in the operating theatre and controls the camera and instruments, which are mounted on robotic arms. The da Vinci system I use gives a magnified, three-dimensional view and instruments with joints that bend like a wrist. It has no independent movement; every movement follows the surgeon’s hands. A surgical team stays beside the patient throughout.
These features help in complex operations deep in the pelvis, such as removing large fibroids and repairing the womb afterwards, or removing deep endometriosis close to the bowel, bladder and ureters.
How the choice is made
For many gynaecological operations, laparoscopic and robotic surgery give similar results. The choice depends on the operation, on what your scans show and on your own circumstances, including what your insurer covers. I recommend the approach that suits your operation and explain my reasons, and keyhole surgery is not right for everyone: occasionally open surgery is the safer option, or an operation that begins as keyhole surgery needs to be converted to an open one.
If you have been told that your operation can only be done through a large open incision, you may find the second opinions page useful.