OPEN SURGERY – this refers to the way traditional surgery was previously done before minimally invasive surgery was introduced by Kurt Semm in 1981. Open surgery or laparotomy entails incising the abdominal was anywhere from 6-14 inches long, depending on the size of the tumor. It may be a midline incision or a transverse “bikini cut”, exposing the lesion to be removed, with the surgeon looking directly in to the operative field exposed through the incisional wound. In the field of Gynecology, in 2002, 80% of surgeries were still done by laparotomy and only 20% done via minimally invasive surgery. Today, especially with the introduction of the robotic platform, only 20% of hysterectomies are done by laparotomy.

Indications for using laparotomy over minimally invasive surgery are not hard and fast but largely depend on the experience and expertise of the surgeon, availabitlity of enabling tools or not:

1. Morbidly obese patient who cannot tolerate the position of laparoscopy or robotic surgery which requires being in the “head down” or Trendelenburg position to make the bowels move out of the operative field.
2. Tumor is so big that it will take hours to morcellate the specimen from the abdomen
3. Massive adhesions
4. Unstable patient conditions where a pneumoperitoneum (instilling carbon dioxide gas into the patient’s abdomen) would further jeopardize the patient’s condition.
5. Advanced ovarian
6. Lack of experienced surgeon & surgical team
7. Lack of a safely functioning lap tower or robot with working instruments