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Comparison of Laparotomy and Laparoscopy
These photographs were taken in the operating room during gynecologic surgery. They graphically demonstrate the differences in incision size between laparotomy and laparoscopy.
 
Laparotomy
A laparotomy incision is usually 6 to 14 inches long. A midline incision is usually made between the umbilicus (belly button) and the pubic bone. Sometimes the incision is extended around and above the umbilicus. A "bikini" laparotomy incision (Pfannenstiel) may be of varying lengths, from a few inches (minilaparotomy) to the entire length between the hip  bones.


Pfannenstiel (Bikini) incision (between 6 and 12")

   
Midline incision (between 6 and 14")
   
Laparoscopy
Operative laparoscopy may require one to four small incisions, each measuring about one quarter of an inch in length. The vast majority of gynecologic procedures require three incisions, one in the umbilicus and two somewhere in or above the pubic hairline.

Laparoscopy incisions are all approximately 1/4" long
   
Working Views
A surgeon operating through a laparotomy incision views the operative field directly. Occasionally, operating "glasses" are used to magnify the field. Usually, however,  gynecologic surgery performed through a laparotomy is done by looking directly into the incision. Laparoscopic surgery, on the other hand, is performed while viewing the operative field on a television monitor. This image is produced by attaching a small videocamera to the end of the laparoscope (which is placed through the umbilicus). The image from this videocamera is projected onto several television monitors in the operating room.

One major advantage offered by laparoscopy is magnification. As the laparoscope is moved closer to tissue, 2x to 7x magnification is achieved. This offers the surgeon a much more detailed look at the operative field, allowing much more meticulous procedures to be performed.

Working through a Laparotomy incision
   
Working through a Laparoscopy incision
   
View of Surgical Team and Inside of Operating Room

This photo demonstrates how laparoscopic surgery is done. The surgeon, scrub nurse, and assistant work while viewing the operation on television monitors. Usually, two monitors are used. One is mounted at the head of the operating table, the other at the foot. The surgeon manipulates instruments, sutures, or lasers while watching the monitor at the foot of the operating table, somewhat like a video game. Often, the entire procedure is videotaped for documentation, teaching purposes, or future review.