When people hear the term minimally invasive surgery, the first thing that often comes to mind is a smaller incision.
That is an important part of it, but it does not tell the whole story.
Minimally invasive surgery refers to a range of surgical approaches that allow surgeons to operate through smaller access points than are typically required for open surgery. Laparoscopic surgery is one of the most familiar examples. Other minimally invasive approaches are used across different areas of surgery.
It is important to understand that minimally invasive does not necessarily mean that it is a minor surgery.
A complex operation involving the removal, reconstruction or joining of internal tissue may still be performed using minimally invasive techniques. Some procedures allow patients to return home on the same day, while others require several days in hospital.
Understanding these distinctions provides a clearer picture of what minimally invasive surgery changes and what still depends on the operation, the patient and the clinical circumstances.
What Is Minimally Invasive Surgery?
In open surgery, the surgeon generally operates through an incision that provides direct access to the area being treated.
Minimally invasive surgery uses smaller access points together with specialised instruments and visualisation systems.
During abdominal laparoscopic surgery, for example, a laparoscope containing a camera is introduced through a small incision. The image from the camera is displayed on a monitor. Additional instruments can be introduced through small access ports to allow the surgeon to perform the procedure.
Carbon dioxide gas is commonly introduced into the abdominal cavity to create working space and improve visualisation of the internal organs.
Laparoscopic surgery is therefore one type of minimally invasive surgery rather than a separate category.
Robot-assisted surgery can also be used to perform selected minimally invasive procedures. In these operations, the surgeon controls the surgical instruments through a robotic-assisted system.
The technique used depends on the operation, the patient’s condition, anatomy, available technology and the experience of the surgical team.
Open Surgery vs Laparoscopic Surgery: What Is the Difference?
The most visible difference between laparoscopic and open surgery is how the surgeon reaches the operative site.
In open surgery, the surgeon generally works through a larger incision that provides direct access to the operative area.
In laparoscopic surgery, the surgeon works through smaller access points while viewing the operative field through a camera system.
| Laparoscopic surgery | Open surgery | |
| Access | Usually several smaller incisions | Usually a larger incision |
| View of the operative field | Camera image displayed on a monitor | Direct view through the surgical incision |
| Instruments | Instruments introduced through access ports | Instruments used through the open incision |
| Recovery | Hospital stay and recovery may be shorter for some procedures | Recovery may be longer for some comparable procedures |
| Suitability | Depends on the procedure and patient | May be preferred or required in particular circumstances |
For selected procedures and appropriately selected patients, laparoscopic surgery may offer short-term recovery advantages compared with open surgery.
For example, guidance from the National Institute for Health and Care Excellence (NICE) on colorectal cancer surgery identifies shorter hospital stays and earlier return to normal activities as advantages associated with laparoscopic resection in patients for whom both laparoscopic and open surgery are considered suitable.
These findings should not be applied to every type of operation. Differences between laparoscopic and open surgery depend on the procedure, patient population, surgical expertise and wider perioperative care.
Open surgery therefore remains an important surgical approach.
Previous operations, scar tissue, inflammation, anatomy, disease extent and circumstances encountered during surgery can all influence which approach is appropriate.
There are also situations in which an operation begins laparoscopically but is changed to an open procedure.
Guidance from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a professional surgical society specialising in gastrointestinal and minimally invasive surgery, recognises conversion to open surgery as one of the options available when difficulties are encountered during laparoscopic gallbladder surgery. Factors such as unclear anatomy or difficult dissection may affect the decision to continue laparoscopically.
Conversion should therefore not automatically be interpreted as a complication. The decision depends on the operative findings and the surgeon’s clinical judgement.
What Procedures Can Be Performed Minimally Invasively?
Minimally invasive techniques are used across many areas of surgery.
Within general surgery, procedures that may be performed laparoscopically include:
- gallbladder removal
- appendix surgery
- selected hernia repairs
- colorectal surgery
- selected stomach and upper gastrointestinal procedures
- removal of the spleen
- selected adrenal procedures
Minimally invasive approaches are also used in fields including urology, gynaecology and thoracic surgery.
Whether a procedure can technically be performed through a minimally invasive approach is only one consideration. It does not mean that the approach will be appropriate for every patient.
The choice depends on the condition being treated, the planned operation, patient anatomy, previous surgery, disease characteristics and other clinical factors.
Does Minimally Invasive Mean Minor Surgery?
No.
This is an important distinction.
Minimally invasive describes the way the surgical site is accessed. It does not necessarily describe the scale or complexity of the operation taking place inside the body.
Colorectal surgery illustrates this distinction. A surgeon may remove a section of bowel using a minimally invasive approach through several relatively small access points. Although the external incisions are smaller than those typically used for open surgery, the internal procedure can still involve extensive tissue dissection, removal of part of the bowel and creation of an anastomosis. It remains a major surgical procedure.
It remains a substantial surgical procedure.
The size of an incision therefore does not, by itself, indicate:
- how complex the operation is
- how long the surgery will take
- whether general anaesthesia is required
- how much tissue will be removed or reconstructed
- how long the patient will remain in hospital
- how long recovery will take
Minimally invasive surgery and minor surgery should therefore not be treated as interchangeable terms.
Can Minimally Invasive Surgery Be Day Surgery?
Some minimally invasive procedures can be performed as day surgery, but the two terms describe different concepts.
Minimally invasive surgery refers to the surgical approach. Day surgery refers to a planned care pathway in which the patient undergoes a procedure and returns home on the same day, without an overnight hospital stay.
Some laparoscopic procedures may be suitable for day surgery in appropriately selected patients. Other minimally invasive operations are more extensive and require one or more nights in hospital.
Whether same-day discharge is appropriate depends on factors including the procedure performed, the patient’s health, the type of anaesthesia and recovery following surgery.
A minimally invasive procedure is therefore not necessarily a day-surgery procedure, just as an operation performed as day surgery is not necessarily minimally invasive.
What Happens Before, During and After Laparoscopic Surgery?
The exact experience varies considerably depending on the operation. However, there are some common elements of laparoscopic surgical care.
Before Surgery
There is no single laparoscopy pre-operative routine that applies to every patient or procedure.
Before surgery, the clinical team may review:
- existing medical conditions
- previous operations
- allergies
- current medicines and supplements
- relevant imaging and investigations
- anaesthetic considerations
Additional tests or assessments may be required depending on the operation and the patient’s health.
Patients also receive instructions about eating and drinking before surgery and whether any medicines need to be adjusted.
The American College of Surgeons advises patients to inform their surgical team about all medicines and supplements they take because some may require adjustment before an operation.
Fasting instructions also depend on the procedure and anaesthetic plan. Patients should follow the specific instructions provided by their surgical and anaesthesia teams rather than changing medicines or fasting requirements themselves.
During Surgery
Although the exact steps depend on the procedure, abdominal laparoscopy commonly follows several basic principles.
After anaesthesia is administered, access to the abdomen is created through a small incision.
Carbon dioxide is introduced into the abdominal cavity to provide working space.
A laparoscope containing a camera allows the surgical team to view the operative field on a monitor.
Additional access points can then be created for surgical instruments.
The surgeon performs the planned procedure using the camera view to visualise the anatomy and operative field.
At the end of the procedure, the instruments are removed and the incisions are closed.
The number, location and size of the access points depend on the operation and surgical technique.
Recovery After Surgery
Recovery depends substantially on what operation was performed rather than simply on whether it was laparoscopic.
After a shorter procedure, a patient may spend several hours recovering from anaesthesia before returning home.
Following more extensive minimally invasive surgery, hospital monitoring may continue for several days.
Temporary discomfort around the incisions can occur after abdominal laparoscopy. Patients may also experience bloating or shoulder discomfort related to the carbon dioxide introduced into the abdomen during the procedure.
The time required to return to usual activities varies according to the operation and individual recovery.
Patients should follow the wound care, activity and follow-up instructions provided by their own surgical team.
How Technology Supports Minimally Invasive Surgery
Performing surgery through smaller access points changes the way surgeons see and interact with the operative field.
Visualisation is particularly important during laparoscopic surgery because the surgeon views the operative area through a camera system rather than directly through a larger surgical incision.
A laparoscopic visualisation system typically brings together the endoscope or laparoscope, camera, light source, image processing and display technologies needed to provide the surgical view.
Visualisation technology has continued to develop. Depending on the system and procedure, available capabilities may include high-definition or 4K imaging, three-dimensional visualisation and fluorescence imaging.
Instrumentation has also developed alongside visualisation.
Surgical instruments need to reach and manipulate tissue through relatively small access points. Depending on the procedure, these may include grasping and dissecting instruments, energy devices, stapling systems and other specialised instruments.
Robot-assisted surgical systems provide another approach to operating through minimally invasive access points for selected procedures.
These technologies address different aspects of minimally invasive surgery. Their relevance depends on the operation being performed and should be considered alongside surgical technique, training and clinical judgement. Read more
How Digital Technology Is Expanding Minimally Invasive Surgery
Minimally invasive surgery has developed alongside advances in imaging, visualisation and surgical instrumentation.
Laparoscopic procedures rely heavily on camera-based visualisation. As a result, many procedures can also generate digital video that may be recorded and reviewed after surgery.
Recorded surgical video can be used for case review, education and research. More recently, artificial intelligence and computer vision have been studied and applied as ways to organise and analyse this information.
For supported procedures, AI-based systems can identify predefined surgical phases or steps and convert a continuous recording into a structured timeline.
This can make it easier for surgeons and educators to navigate a completed procedure, return to particular stages and examine patterns across cases.
The information still needs to be considered within its clinical context. Differences in procedural timing or workflow may be influenced by patient anatomy, disease characteristics, previous surgery, procedural complexity and other circumstances.
AI-based analysis can therefore provide an additional source of structured information for surgical review and learning alongside clinical experience and professional judgement. Read more
Choosing the Appropriate Surgical Approach
Minimally invasive techniques have expanded the surgical approaches available for many procedures, but the choice of approach depends on more than incision size.
The operation being performed, patient anatomy, disease characteristics, previous surgery and other clinical considerations can all influence whether a laparoscopic, robot-assisted, open or another surgical approach is appropriate.
For selected procedures and appropriately selected patients, minimally invasive surgery may offer short-term recovery advantages. In other circumstances, open surgery may provide the access needed to perform the operation.
The important distinction is therefore not simply between large and small incisions.
Minimally invasive surgery represents a different way of accessing and visualising the operative field while performing the required procedure. The appropriate approach remains the one suited to the individual patient, procedure and clinical circumstances.
References
- National Institute for Health and Care Excellence (NICE). Laparoscopic Surgery for Colorectal Cancer. Technology Appraisal Guidance TA105. NICE recommends laparoscopic resection as an alternative to open resection when both approaches are considered suitable and discusses differences in hospital stay and return to normal activities.
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Guidelines for the Clinical Application of Laparoscopic Biliary Tract Surgery. Guidance addressing patient selection, laparoscopic technique, conversion to open surgery and postoperative management.
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Safe Cholecystectomy Multi-Society Practice Guideline. Guidance addressing operative decision-making and management of difficult laparoscopic cholecystectomy.
- American College of Surgeons (ACS). Medication and Surgery: Before Your Operation. Patient guidance on reviewing prescription medicines, vitamins, herbs and supplements before surgery.
- American Society of Anesthesiologists (ASA). Practice Guidelines for Preoperative Fasting. Guidance on preoperative fasting for patients undergoing procedures requiring anaesthesia or procedural sedation.
This article is intended for general educational purposes and does not replace individual medical advice, diagnosis or treatment from a qualified healthcare professional.