Is closed surgery or open surgery better?

Surgical procedures, which are among the most effective methods used in the treatment of diseases, are undergoing a significant transformation thanks to advancements in medicine. While conventional methods are becoming less preferred in many aspects, the concept of minimally invasive (closed) surgery is gaining increasing attention.

Although both surgical methods have their own advantages, laparoscopic surgery—commonly known as closed surgery—provides significant comfort for both patients and physicians. While open surgery may become a necessity rather than a choice in some cases, choosing laparoscopy, if recommended by the physician, offers many advantages [1].

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Laparoscopic (closed) surgery is a modern surgical approach that is recommended whenever possible due to less pain, shorter recovery time, and a lower risk of complications.

What Is Open Surgery?

Open surgery is a classical surgical procedure performed under general anesthesia or high spinal anesthesia, where the skin and underlying tissues are incised to reach the diseased organ or tissue. The aim is to access and treat the affected area through an incision made close to the relevant region.

The incision length is larger compared to closed surgery, and pain is usually more significant. At the same time, the risk of infection may be higher. Another disadvantage of open surgery is the relatively longer recovery period. Compared to laparoscopic surgery, recovery time may differ by at least 1–2 weeks. Studies show that the return to normal activity after open hysterectomy is approximately 37 days on average [2].

What Is Closed Surgery (Laparoscopy)?

Laparoscopy, also known as closed surgery, is a procedure in which access to the abdominal cavity is achieved through small incisions ranging from 3 millimeters to 1 centimeter using tubes called trocars. During this procedure, an optical device with a camera at its tip and other surgical instruments are inserted into the abdomen.

This method is especially practical in the treatment of gynecological conditions, as the internal reproductive organs are located within the abdominal cavity. Through the inserted camera, the physician can clearly visualize the organs and perform treatment using specialized instruments [1].

For more detailed information about laparoscopy, you can visit our page what is laparoscopy and why is it performed?.

Which Gynecological Conditions Are Treated with Laparoscopy?

Laparoscopic surgery is a minimally invasive approach that is recommended by ACOG whenever feasible instead of open surgery [1]. The main gynecological conditions treated include:

• Infertility surgery
• Removal of ovarian cysts
• Removal of the uterus or ovaries (laparoscopic hysterectomy)
• Tubal ligation or removal
• Removal of fibroids
• Surgical treatment of infections (such as abscesses)
• Diagnosis or removal of pelvic masses
• Diagnosis and treatment of urinary incontinence
• Diagnosis and treatment of cervical cancer
• Correction of pelvic organ prolapse
• Treatment of uterine cancer

Why Choose Closed Surgery?

The evidence-based advantages of laparoscopic surgery compared to open surgery include:

• Less postoperative pain and tenderness
• Faster recovery and quicker return to daily life
• Less blood loss during surgery
• Minimal or no visible scarring
• Significantly lower risk of hernia
• Reduced risk of intra-abdominal adhesions
• Lower infection risk and shorter hospital stay

For more information about fibroid surgery, you can visit our page what is fibroid surgery and who is it suitable for?.

Frequently Asked Questions (FAQ)

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  Can every surgery be performed laparoscopically?

  No. In cases such as very large uterus, extensive adhesions, or advanced-stage cancer, open surgery may be required. The decision depends on the clinical condition and the surgeon’s experience.

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  How long is the recovery time after closed surgery?

  Return to normal activity usually occurs within 22–25 days, which is approximately 13 days faster than open surgery. However, this may vary depending on the extent of the procedure and the patient’s overall health.

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  Is closed surgery safer?

  Generally, yes. It offers lower infection risk, less blood loss, and faster recovery. However, the experience of the surgical team is critical.

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  How long is the hospital stay after surgery?

  Laparoscopic surgery usually requires a hospital stay of 1–2 days, whereas open surgery may require a longer stay.

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  Is robotic surgery different from laparoscopy?

  Robotic surgery is a technologically assisted version of laparoscopic surgery. While outcomes are generally similar, the cost is higher and it may not be available in all centers.

References

1. American College of Obstetricians and Gynecologists (ACOG). (2017). Choosing the Route of Hysterectomy for Benign Disease.
2. Pickett, C. M., et al. (2023). Surgical approach to hysterectomy for benign gynecological disease.