How many holes does a laparoscopy have?

September 23, 2025 •

4 min read

The number of incisions, or 'holes,' in a laparoscopy is a key feature of this minimally invasive approach, with most patients requiring only 2 to 4 small cuts, often less than an inch long. This technique, also known as keyhole surgery, allows surgeons to perform procedures with less trauma to the body compared to traditional open surgery.

Quick Summary

The number of incisions in a laparoscopy is not fixed, typically ranging from two to five depending on whether it is for diagnostic purposes or a more complex surgical procedure. The specific number of access ports is determined by the size and complexity of the operation.

Key Points

Variable Incisions: The number of holes in a laparoscopy is not fixed, typically ranging from 2 to 5 depending on the complexity of the procedure.
Diagnostic vs. Surgical: Diagnostic procedures use fewer incisions (often 2–3) than more complex surgical interventions, which require additional ports for specialized instruments.
Minimally Invasive: Fewer and smaller incisions are the key benefit, leading to less pain, smaller scars, and a faster recovery compared to open surgery.
Camera and Instruments: One incision is always used for the laparoscope (a camera), while other holes provide access for surgical tools.
Recovery: Post-procedure recovery is generally quick, with many patients returning home the same day and experiencing less discomfort than with traditional surgery.
Gas Pain: Shoulder pain is a common temporary side effect after laparoscopy, caused by the carbon dioxide gas used to inflate the abdomen during the procedure.

The Variable Nature of Laparoscopic Incisions

Unlike traditional open surgery, which involves a single large incision, a laparoscopy utilizes several small incisions, or 'ports.' The exact number is not universal and depends on several factors, primarily the purpose and complexity of the procedure being performed. For a simple diagnostic examination, fewer ports are needed, whereas a complex surgery, such as organ removal, requires additional access points for specialized instruments.

Factors Influencing the Number of Holes

Procedural Complexity: A simple diagnostic procedure to view the abdominal organs may only require one or two small incisions. In contrast, a cholecystectomy (gallbladder removal) or a laparoscopic hysterectomy will necessitate several additional ports to accommodate the surgical tools required for dissection, cutting, and removal of the organ.
Surgeon's Technique: The surgeon's experience and the specific tools they use can also affect the number and placement of incisions. Some specialized techniques or robotic-assisted surgery may utilize a different configuration of ports.
Patient Anatomy: A patient's individual anatomy, including the presence of prior surgical adhesions or excess weight, can influence the number and location of incisions required for adequate visualization and access.

A Breakdown of Incisions by Procedure Type

Diagnostic Laparoscopy

For a purely diagnostic laparoscopy, the procedure is often simpler, and the goal is just to visualize the abdominal or pelvic organs.

Number of holes: Typically 2 to 3.
Placement: The first incision is usually made in or near the belly button (umbilicus) for the laparoscope (camera). One or two additional small incisions may be made in the lower abdomen to insert instruments for manipulating the organs and better visualization.

Laparoscopic Gallbladder Removal (Cholecystectomy)

This common procedure is a great example of a laparoscopic surgery involving several instruments to complete the operation.

Number of holes: Typically 3 to 4.
Placement: One incision near the belly button for the camera, and 2 to 3 other incisions are made in the upper abdomen to introduce surgical tools. The gallbladder is then removed through one of these ports.

Laparoscopic Hysterectomy

This more involved surgery often requires a greater number of ports to remove a larger organ like the uterus.

Number of holes: Often 4 to 5.
Placement: Incisions are strategically placed to allow the surgeon multiple angles of approach. One port for the camera, and the others for various instruments to cut, coagulate, and manipulate tissue, as well as to remove the organ.

Laparoscopy vs. Open Surgery: A Comparative View


Feature	Laparoscopy	Open Surgery
Incision Size	Multiple small incisions, typically 0.5–1 cm	One large incision, 6–12 inches long
Invasiveness	Minimally invasive, reduced tissue disruption	Highly invasive, significant tissue trauma
Post-Op Pain	Significantly less pain, less need for medication	More severe pain, higher reliance on pain medication
Scarring	Smaller, less noticeable scars	Larger, more prominent scars
Recovery Time	Faster recovery, shorter hospital stay	Longer recovery period and hospital stay
Risk of Infection	Lower risk of wound infection	Higher risk of wound infection due to larger incision

The Surgical Process: From Incision to Recovery

The Entry Point and Insufflation

The process begins after the patient is under general anesthesia. The surgeon makes the first small incision, usually at the navel. A thin needle is then inserted to insufflate the abdominal cavity with carbon dioxide gas. This inflates the abdomen, lifting the abdominal wall away from the organs to provide the surgeon with a clearer view and more working space.

Inserting Instruments

Once the abdomen is inflated, a trocar (a hollow tube) is placed through the first incision, and the laparoscope—a small telescope with a video camera—is inserted through it. The images are displayed on a video monitor in the operating room. Next, the surgeon makes the other small incisions, placing additional trocars to insert the necessary surgical instruments, such as forceps, scissors, and staplers, to perform the procedure. After the surgery is completed, the gas is released, the instruments are removed, and the incisions are closed with stitches, surgical tape, or glue.

For a detailed overview of what to expect during laparoscopic surgery, you can find more information on the Johns Hopkins Medicine website.

What to Expect Post-Procedure

Recovery from a laparoscopy is typically much faster than from open surgery. Many patients can go home the same day. You can expect some discomfort and soreness around the incision sites. It is also common to experience referred shoulder pain for a few days, which is caused by residual carbon dioxide gas irritating the diaphragm. Walking around can help relieve this gas pain. Your doctor will provide specific instructions for post-operative care, including managing pain, keeping the incision sites clean, and knowing when to resume normal activities.

Conclusion

The question, "How many holes does a laparoscopy have?" does not have a single answer, as the number is tailored to the specific procedure, patient, and surgical needs. While it is always a small number, usually between two and five, the key takeaway is that this minimally invasive approach leads to significantly less pain, scarring, and a much faster recovery than traditional open surgery. Consulting with your surgeon is the best way to understand the specifics of your procedure.

Frequently Asked Questions

A laparoscopy is often called keyhole surgery because it is performed through several very small incisions, or 'keyholes,' in the abdomen, rather than a single large opening like in traditional open surgery.

The incisions for a laparoscopy are quite small, typically measuring between 0.5 and 1.5 centimeters (less than an inch) in length. They result in much smaller and less noticeable scars than open surgery.

Generally, a lower number of incisions may contribute to a slightly quicker recovery, but the overall healing time is more influenced by the complexity of the surgery performed through the holes. However, any laparoscopic procedure almost always results in a faster recovery than open surgery.

While the average is 2 to 5, the number can be higher for more complex or extensive procedures. Some advanced or robotic-assisted surgeries might require more access points, but it is still far fewer than the large incision required for open surgery.

The extra holes or ports are needed to insert additional surgical instruments. The surgeon uses one hole for the camera to see inside and others to manipulate, cut, and remove tissue or organs, similar to how a person uses multiple hands to perform a task.

Yes, but the scarring will be minimal compared to open surgery. The small incisions typically heal into very small, less noticeable scars that fade over time.

Some procedures, especially purely diagnostic ones, may involve only one incision, often through the navel. However, most surgical interventions require multiple access points to accommodate instruments for a safe and effective operation.

In rare cases, a surgeon may discover complications during a laparoscopic procedure that necessitate converting to a traditional open surgery with a larger incision for better access or control. This happens when the original plan is deemed unsafe.