Traditional open surgery is the preferred approach in certain cases. For example, a patient who has had previous abdominal surgery, there are likely to be bowel adhesions from scar tissue. Such a patient would be unsuitable for abdomino-pelvic robotic or key-hole surgery, as the laparoscopic port placement could injure the bowel. This patient would require open surgery.
Other patients are obese and or have cardio-pulmonary conditions that preclude them from being placed in the head down position which is required for robotic prostate surgery. The steep head down is approximately 26 to 28 degrees head down. Such patients will be unable to be ventilated adequately with the anaesthetic machine, and they would be more suited to open surgery, which is performed in the flat supine position.
Certain kidney or prostate cancers are locally advanced. They include lymph node involvement and or complex vascular invasion. These are more suited to traditional open surgery in order to achieve tumour clearance, without bleeding or other complications.
Central kidney cancers in close proximity to the renal vessels, and or endophytic in position, are often better suited to open partial nephrectomy rather than robotic.
Vaginal or pelvic mesh that has eroded into the bladder creates a condition called VVF, Vesico-vaginal Fistula. In order to fix this problem, open pelvic surgery is required.
Certain bladder and ureteric operations are best performed through an open approach. For example, a bladder diverticulum with cancer within it, where there has been intra-vesical chemotherapy used, tends to be very adherent to the pelvic side wall. It is safer to perform this surgery open, to reduce bleeding risks.