Minimally Invasive vs. Open Surgery – What’s Right for You?

Open surgery and minimally invasive surgery have more in common than you might think. And both are great options for the treatment of pelvic floor disorders.

Woman in hospital bed awaiting surgery at University of Colorado Urogynecology | Denver, CO

Having a medical condition that requires a planned surgery can be stressful and you will probably have a lot of questions running through your head:

  •  What questions should I ask when choosing a surgeon?
  •  How many days will I be in the hospital?
  •  How long will recovery take?
  •  How much pain will I be in?
  •  Will I have visible scars?

Here at University of Colorado Urogynecology we focus on surgeries for female pelvic health: hysterectomy (complete removal of the uterus), sacrocolpopexy (laparoscopic vaginal prolapse repair), colporrhaphy (vaginal wall repair), perineorrhaphy (plastic surgery for vagina or anus), vaginal reconstruction and others.

Our doctors perform surgical procedures in one of two ways: laparoscopically, or via open surgery. And the type of procedure chosen will help to answer some of the above questions.

Laparoscopic surgery is a type of minimally invasive procedure that is performed by making several small (usually ¼ of an inch) incisions in the abdomen and inserting a laparoscope – a small tube with a light and camera – and small surgical instruments to perform the surgery. Laparoscopic surgeries can also be done robotically, allowing the surgeon to have 360 degrees of motion, which a hand cannot do. Minimally invasive procedures tend to have less blood loss, shorter hospital stays and less risk of infection than open surgical procedures.

Open surgery is performed by creating a single, larger incision (typically around 3 inches) in the lower abdomen so that the surgeon can access the pelvic area that needs to be repaired/removed. Open surgical procedures have become less common since the creation of minimally invasive surgery.

During surgeries for female pelvic health, we usually have a vaginal component to both open and minimally invasive procedures.

Similarities between open and minimally invasive surgery for female pelvic health

All of the surgeries we do can be done with open or minimally invasive approaches and both are great options for pelvic health surgeries. And the truth is, it doesn’t really matter how a surgeon performs a surgery. While a minimally invasive procedure may have a slightly shorter recovery time, the quality and success rates of each type of surgery are the same. Sometimes, open surgery is the safer and more effective approach.

As with all surgical procedures, general risks include blood loss, pain, infection and possible reaction to anesthesia.

Which type of surgery should you choose?

When both types of procedures are appropriate for the particular patient and the surgeons are all highly skilled, as in the case with CU Urogynecology, the decision between open vs. minimally invasive surgery is guided by the patient’s preference and the surgeon’s experience. 

Will you have visible scars?

Shown in the image below are the typical incision placements for both surgeries. The first photo shows a patient with four small laparoscopic incisions that are strategically placed throughout the lower abdomen. Sometimes, we can even hide an incision in the belly button.

The second photo shows a typical open surgery incision placed right below the bikini line, a scar that can later be easily hidden in a two-piece bathing suit. If aesthetics is an issue, or if a woman already has a previous C-section scar, she may opt for open surgery.

Comparison of laparoscopic and open scar placement for female pelvic surgery | University of Colorado Urogynecology | Denver, CO

Will health history affect your decision?

The patient’s health history is also a factor when making the decision on which type of procedure will be best. Patients who are obese or who have a history of serious heart and lung problems may not be candidates for minimally invasive surgery. It’s also not ideal for a patient to be under anesthesia for a prolonged period of time, so if a procedure can be done faster with one approach over the other, that should also be taken into consideration.

How long will you stay in the hospital?

Due to the smaller incisions and less risk of infection, patients who receive a minimally invasive procedure may be able to go home the day of the operation or stay in the hospital overnight. Patients who have open surgery are typically in the hospital for 1-2 days so that we can help monitor the incision and manage infection risk.

What is the recovery time for each surgery?

Both minimally invasive and open surgery take about 6-8 weeks to fully recover from. So just because you have minimally invasive surgery and don’t have a large incision or a great amount of pain, that does NOT mean you can go back to half marathon training or skiing a week after surgery. Both procedures require the same number of follow-up appointments with your doctor.

At CU Urogynecology, we have doctors who specialize in each type of surgery. Dr. Marsha Guess specializes in open surgery while I – Dr. Lauren Rascoff – specialize in minimally invasive robotic surgery. Dr. Kathleen Connell does both types of surgeries and her decision as to which type of surgery to perform is based on the patient’s health history and preference. Patients can schedule a consultation with any of our doctors to discuss which surgical option is best.