Open surgery is the traditional way of operating. This involves making a long cut in the abdomen or chest, cutting through the skin, fat, muscles, and all layers to get to the required organ. This is equivalent to breaking through a wall to gain access to a piano inside a room.
An old saying in surgical textbooks is, “big surgeons make big incisions.” This no longer applicable and has not been for the last three decades. Now it can be said that a ‘big surgeon makes small incisions”. Professor Nisar does not believe that the measure of a surgeon is based on the size of the incisions, rather one should be a safe and sensible surgeon offering the best possible care to one’s patient. Safety first, safety is paramount.
Making an 8-12 cm cut for an appendix, a 10-12 cm incision for a hernia, or a 15-20 cm opening for gallbladder surgery are the things of the past. All these surgeries are being done laparoscopically and have been for nearly 30 years. This means the operations have better results and outcomes; this is based on evidence recognized by the monetary bodies in the United Kingdom, Europe, and the US.
Nowadays, only less than 5 % of these operations require an open approach. Surgeons with expertise, good eye-hand coordination, training, and adequate laparoscopic skills should be able to do the majority of their operations in the abdomen, chest, or pelvis safely with this technique.
Open surgery has its place, as does laparoscopic surgery. It is just another way of doing surgery. A surgeon should offer both options to the patients, discuss the merits and demerits of both. Upon assessing both options, a decision should be made based on the patient’s condition.