In open surgery, an incision is made and the surgeon directly visualizes and handles the tissues in order to perform the operation. By contrast, laparoscopic surgery avoids a large incision by utilizing a camera and scope system to project images from within the body onto a monitor. A camera attached to a thin, long, lighted scope, and other instruments are inserted through small incisions, typically 1 cm or less in size. The positions of trocars are strategically chosen to provide the best approach to the area of interest. Once access to the abdomen is established, carbon dioxide is insufflated into the peritoneal cavity to create pneumoperitoneum. The insufflation pressure distends the abdominal wall outward, creating enough room for the surgeon to work. In the thoracic cavity, once the lung is deflated, the ribs maintain a rigid structure allowing thoracoscopy to be performed without insufflation.

Many if not most procedures that can be performed open can also be performed laparoscopically. In fact, for several operations such as cholecystectomy, appendectomy, and fundoplication, the laparoscopic approach has become the standard of care. Laparoscopic surgery carries the obvious advantage of smaller incisions and thus a more cosmetic postoperative appearance. However, numerous additional benefits to laparoscopy exist, including reduced postoperative pain, fewer pulmonary complications, lower rates of wound infection, a shorter hospital stay, and fewer adhesions. Of note, the laparoscopic approach is strongly preferable in obese patients, since the morbidities associated with a large incision can be entirely avoided.

Despite the advantages afforded by laparoscopy, there are also certain disadvantages to this approach. In general, laparoscopy is technically more difficult and requires specialized training. In addition, laparoscopic cases carry risks unique to laparoscopy, including those related to trocar placement and pneumoperitoneum. Laparoscopy is not well suited to all patients; indeed, there are several instances where open surgery is advantageous. For example: (1) in trauma patients, rapid control of hemorrhage including direct manual compression of bleeding sites may be needed; (2) laparoscopy is difficult in the presence of extensive adhesions from previous operations or an intra-abdominal inflammatory process; (3) some patients with borderline pulmonary reserve cannot tolerate the reduced lung volumes caused by pneumoperitoneum and the resultant increased intrathoracic pressures; (4) the presence of extremely dilated bowel can make laparoscopy difficult since there is little room left to work; furthermore, dilated bowel is thin-walled and easily injured when grasped with laparoscopic instruments; and (5) when surgery is being performed for the resection of a large tumor, an incision may be necessary to extract the specimen.