All surgical techniques that involve an incision in the abdominal wall within the field of gynecologic laparotomy surgery. Therefore, a laparotomy incision may vary between 10 and 15 cm.. Cutting can be trasversal, then horizontal, or longitudinal, and vertical from the pubis to the navel, and sometimes beyond. The incision during surgery, penetrates the thickness of the abdominal wall and will be kept open usingi metal valves. This will allow the surgeon to use, with greater ease, both hands and the necessary tools within the abdominal cavity. For years the preferred approach had been the use of traditional laparotomy surgery, which for accessing to the pelvic cavity in many cases provides for an incision in the skin. This was the procedure normally followed. This surgical approach is related to significant levels of post-surgery pain and the long recovery time, preventing the patient from returning quickly to her daily activities. For this reason the laparotomy approach is reserved for a more restricted number of cases, and is carefully selected, favouring the laparoscopic or vaginal surgery.

This approach is proposed when the vaginal laparotomy and the laparoscopic one are not recommended. Although the latter may offer many potential benefits to women in terms of fewer complications, hospital stay, and recovery time, there are some disadvantages in some specific situations. Vaginal surgery provides for small working spaces, making rather difficult to get a clear view of the organs contained inside the pelvis. This surgical procedure is poorly indicated when the pubic arch is very narrow, or if there are certain adhesions from previous surgery (such as a Caesarean section) and if there are signs of severe endometriosis or an advanced malignancy, or other anomalies that haven’t been localized, and require more extensive procedures which could also include the removal of the lymph nodes. The laparoscopic technique is indicated with not very complicated surgeries, limited in duration. This technique, in fact, has characteristics that may make it less precise and/or accurate than the traditional laparotomy, as it only offers a two dimensional view rather than a three-dimensional one. Maneuverability of the surgical instruments is also more difficult and the workspace is reduced. Years of experience are required for this type of technique.

The vaginal surgical approach offers many advantages over traditional laparotomy. Spinal anesthesia, which often is, and then only affects the lower part of the body, results in faster post-surgery recovery, eliminating the surgical trauma caused by a laparotomy incision. This makes the vaginal approach applicable in all those cases, in which surgery and anesthesia would be risky for the patient, especially the elderly ones, or those suffering from obesity or from debilitating ailments such as diabetes or cardiovascular diseases.

Among its advantages, the vaginal surgical technique doesn’t require a general anesthesia. Instead, a spinal anesthesia (which numbs only the lower part of the body) can be administered. In this way, all the risks associated with general anesthesia are avoided, favoring faster patient recovery.

A laparotomy allows the surgeon a much better advantage when performing a procedure on the abdominal and pelvic organs. Each surgeon makes a certain type of incision that has its advantages and its limitations. In principle the abdominal surgical approach is used in most gynecological malignancies, tumors of the uterine cervix, ovarian cysts and endometriosis, in the case of a Cesarean section, myomectomy, hysterectomy, or when removing complex ovarian cysts, and in cases when it isn’t necessary to perform reconstructive surgeries for malformations of the genital tract.