Laparotomy — Traditional Surgery
A laparotomy incision is usually 6 to 14 inches long. A midline incision is usually made between the umbilicus (belly button) and the pubic bone. Sometimes the incision is extended around and above the umbilicus. A ‘bikini’ laparotomy incision may be of varying lengths, from a few inches to the entire length between the hip bones.
Laparoscopy — Minimally Invasive Surgery [MIS]
Operative laparoscopy may require one to four small incisions, each measuring about one quarter of an inch in length. The vast majority of gynecologic procedures require three incisions, one in the umbilicus and two somewhere in or above the pubic hairline.
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:
- Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
- Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
- Less pain, leading to less pain medication needed.
- Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
- Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
While laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult
from the surgeon's perspective when compared to traditional, open surgery:
- The surgeon has limited range of motion at the surgical site resulting in a loss of dexterity.
- Poor depth perception.
- Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.
- The tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn.
Working Views and Differences
A surgeon operating through a laparotomy incision views the operative field directly. Occasionally, operating ‘glasses’ are used to magnify the field. Usually, however, gynecologic surgery performed through a laparotomy is done by looking directly into the incision. Laparoscopic surgery, on the other hand, is performed while viewing the operative field on a television monitor. This image is produced by attaching a small video camera to the end of the laparoscope (which is placed through the umbilicus). The image from this video camera is projected onto several television monitors in the operating room.