Here’s the honest version, without the jargon. Both can do the same operation. The difference is mostly in how the surgeon reaches the part of your body that needs fixing — and that difference shapes your pain, your scars and how fast you get back to normal life.

Dr Ameet Kumar — AIIMS-trained, FRCS (Glasgow), with over 4,500 surgeries across 25 years — uses the keyhole approach for nearly every operation he does. But not for every case, and he’s the first to say so. This article explains why.

In traditional open surgery, the surgeon makes one long cut to reach the organ they’re working on, and operates by looking and working directly through that opening.

In laparoscopic surgery — also called keyhole or minimally invasive surgery — the same operation is done through a few small cuts instead, each usually less than a centimetre. A slim telescope with a camera goes through one cut and sends a magnified, high-definition picture of the inside of your body onto a screen. The surgeon works through the other tiny openings using fine instruments.

The key word is same. Keyhole isn’t a lighter or shortcut version of the operation. The organ is removed or repaired in exactly the same way, to exactly the same standard. Only the way in is different.

When the same operation is done by keyhole instead of open, here’s what tends to change for you:

These aren’t small things. For most people, they add up to an easier, quicker return to ordinary life — work, family, walking, sleeping comfortably.

It’s tempting to assume newer and smaller is always better. It usually is — but not always, and a careful surgeon won’t pretend otherwise.

Keyhole surgery depends on the surgeon being able to see clearly and work safely through small openings. When something gets in the way of that — heavy scarring, severe inflammation, bleeding, or anatomy that’s hard to make out — forcing a keyhole approach can make the operation less safe, not more.

That’s the whole point. The goal was never ‘the smallest possible cut.’ The goal is the safest, most thorough operation for you. The keyhole approach is simply the best way to deliver that most of the time — and open surgery is the right way the rest of the time.

So the honest answer is: keyhole is better for most operations, most of the time. Not all, and not for everyone.

There are real situations where Dr Kumar may recommend an open operation from the start — because it’s genuinely safer for you:

There’s also a third possibility worth knowing about: sometimes a surgeon will start the operation by keyhole and switch to open partway through. This is a planned, deliberate choice — made the moment the safer path becomes clear, for example if there’s unexpected bleeding or scarring that can’t be handled safely through the small openings.

This is important: a switch to open is not a complication or a failure. It’s a sign that your surgeon is putting your safety ahead of a tidy scar. The best outcome is always the safe one — never the one that simply looks neater.

The right approach isn’t decided by habit, or by which method sounds more impressive. It’s decided by you — your scans, your history, the exact problem being treated, and sometimes what’s found once the operation is underway.

This is where experience matters most. Offering keyhole surgery for a simple operation is one thing. Knowing how to take the keyhole approach safely into the hardest operations in the abdomen — and knowing exactly when not to — comes only from doing the difficult cases, again and again.

Dr Kumar was among the first surgeons in the Armed Forces Medical Services to perform a totally laparoscopic Whipple’s operation — one of the most complex procedures in surgery, and one most centres still do open. That same judgement is what tells him, in your case, whether keyhole is the better choice or whether open is the safer one.

When you meet him, he’ll look at your reports and tell you plainly which approach he recommends and why — in language you can follow, with your questions answered honestly. Because across this practice, the principle is the same: surgery is only ever advised when it’s truly the right thing for you. And the same goes for how it’s done.