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When a patient is told they need surgery, the conversation often turns to the "how." In modern healthcare, surgeons have more tools than ever to tailor a procedure to a patient's specific needs. At Olympic Medical Center, general surgeon Sam Skovgaard, MD, works with patients to determine the most effective surgical path for them—whether that is a traditional "open" approach or a minimally invasive laparoscopic technique.

Choosing the right path: Laparoscopic vs. Open Surgery

When it comes to surgery, the technique comes down to what’s best for the patient. While laparoscopic surgery is often the preferred choice when a patient is a candidate, it is important to understand how it differs from traditional methods:

• Laparoscopic Surgery: Often called "minimally invasive," this technique uses a few small "buttonhole" incisions. A laparoscope—a thin tube with a high-resolution camera—is inserted, allowing the surgeon to see inside the body on a monitor and use specialized tools to perform the operation.

• Open Surgery: This is the "traditional" method, requiring a single, larger incision to provide the surgeon with a direct view and physical access to the surgical site.

Why are different methods used? The choice between these two approaches isn't just about the size of the scar; it is about the safest manner to achieve a successful outcome. "Laparoscopy is an excellent tool, but it isn’t always the right choice for every patient," explains Dr. Skovgaard. When deciding between laparoscopic and open surgery, surgeons will ask themselves, “How can we do this safely? And how can we do this properly?” Determining if a patient is a candidate for laparoscopic surgery or not always has to do with what is best for the patient’s outcome.

What to expect post-op

The primary advantage of the laparoscopic approach is the reduced trauma to the body, which often leads to a faster and more comfortable recovery.

The one-week milestone While every recovery looks different, Dr. Skovgaard notes that many laparoscopic patients begin to feel significantly better within about one week. Because the incisions are small, there is typically less post-operative pain and a reduced risk of infection compared to larger open incisions. This allows many patients to return to light daily activities and work sooner than they would with traditional surgery.

Managing post-op pain Even with a minimally invasive approach, the body needs time to heal. Dr. Skovgaard is careful to prepare patients for a few specific discomforts:

• Bloating and gas: During the procedure, the abdomen is gently inflated with carbon dioxide gas to provide the surgeon with a clear field of vision. It is common to feel "gaseous" or bloated for several days afterward as the body absorbs this gas. Some patients also experience pain in their shoulder or collar bone area.

• Incision sites: While usually small, the number of incisions can vary. "Sometimes there are three, but depending on the instruments needed, there could be more," says Dr. Skovgaard. The size of these incisions and their healing time is dictated by the specific tools required for that particular surgery.

Lower risk of long-term complications

The smaller incisions used in laparoscopic surgery also reduce the risk of surgical site infections, hernias, and fewer surgical adhesions which reduce the risk of future small bowel obstructions

Surgical wound infections typically occur in the first few weeks after surgery, and are less likely in smaller, laparoscopic incisions.

Any abdominal surgical incision carries the long-term risk of developing into a hernia. Smaller incisions used in laparoscopic surgery are much less likely to develop into hernias.

Scar tissue which causes abdominal organs to fuse together or stick to the inside surface of the abdominal wall are called adhesions. Adhesions will always form to a certain extent after any abdominal surgery or large abdominal infection, but less so after laparoscopic surgery. These adhesions can cause a condition called adhesive small bowel obstruction, where the intestines get “kinked,” similar to how a garden hose can get kinked off and obstruct flow. The long term risk of small bowel obstruction is lower with laparoscopic surgery.

Surgical procedures at Olympic Medical Center

At Olympic Medical Center, we use laparoscopic techniques for a range of general surgeries right here in Port Angeles. These include:

• Cholecystectomy (gallbladder removal)

• Appendectomy (appendix removal)

• Hernia Repairs: inguinal hernias, ventral hernias, hiatal hernias

• Colectomies (for diverticulitis or colon cancer)

• Colostomy creations/reversals

• Biopsies in the abdominal cavity

• Small Bowel Obstruction Surgery (Lysis of Adhesions)

• Splenectomy

• Explorations following trauma (like a stab wound to the abdomen)

• Feeding Tube Placements

Expert care, close to home

By offering both advanced laparoscopic and traditional surgical options, Olympic Medical Center ensures that residents have access to high-quality, precise care without the need for travel off the Peninsula. Whether surgery is minimally invasive or traditional, the goal remains the same: a safe, successful outcome that gets you back to a life with less pain or illness.

"Our focus is always on what is best for the individual sitting in front of us," says Dr. Skovgaard. "By providing these advanced options close to home, we can support our patients through every step of their surgery and recovery."

Learn more about laparoscopic surgery and general surgery at Olympic Medical Center by visiting olympicmedical.org/services/general-surgery. To make an appointment, visit your primary care provider to request a referral.