Keyhole (laparoscopic) tummy surgery
An operation inside a child's tummy done through a few small cuts using a camera and fine instruments, instead of one larger cut.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Keyhole surgery does the operation through a few small cuts using a camera and fine instruments, often meaning smaller scars, less pain and a faster recovery than open surgery.
- It is a way of operating, not a different operation – the goal is the same as the open version.
- The surgeon may need to switch to a larger open cut during the operation if it is safer; this is not a failure but a sensible safety decision.
- It is done under a general anaesthetic and still carries real surgical and anaesthetic risks, so consent should cover the specific operation your child is having.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Smaller cuts and usually smaller scars
Operations or situations where keyhole surgery cannot be done safely or as effectively as open surgery.
Your child wakes from the anaesthetic in recovery. They may be sleepy or feel sick, and have some pain around the cuts and possibly the shoulder tip from...
Clear pain-relief advice and written instructions for caring for the small cuts.
Your child wakes from the anaesthetic in recovery. They may be sleepy or feel sick, and have some pain around the...
Shoulder-tip pain and tummy discomfort usually ease. Many children go home as a day case or after a short stay...
Pain settles and energy returns. Many children are back at nursery or school within about a week, depending on the...
Most children return to normal activities, with the surgeon advising on sport, swimming and any lifting. Internal...
What is keyhole (laparoscopic) tummy surgery?
Keyhole surgery, also called laparoscopic or minimally invasive surgery, is a way of operating inside the tummy through a few small cuts rather than one large one. The surgeon passes a thin telescope with a camera (a laparoscope) through one small cut, usually at the tummy button, and watches a magnified picture on a screen. Fine instruments go through other tiny cuts to do the operation.
To create space to see and work, the tummy is gently filled with carbon dioxide gas. The same gas is let out at the end. Many different children's operations can be done this way – for example removing the appendix or gallbladder, fixing a hernia, or operations on the bowel or other organs.
Keyhole surgery is a way of carrying out an operation, not a different operation in itself. The aim is the same as open surgery, often with smaller scars, less pain and a quicker recovery. It is not always possible, and the surgeon may need to change to a larger (open) cut during the operation if that is safer for your child.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Keyhole compared with open surgery
| Feature | Keyhole (laparoscopic) | Open surgery |
|---|---|---|
| Cuts | A few small cuts | One larger cut |
| Scars | Usually smaller | Usually larger |
| Pain after | Often less | Often more |
| Recovery | Often faster | Often slower |
| When chosen | When suitable and safe | When keyhole is not suitable or safe |
Keyhole is not always possible or best. The surgeon decides based on the operation, your child's anatomy and what is found during surgery, and may convert to open surgery for safety.
Preparing for your surgery
- Meet the surgeon to discuss why the operation is needed, whether keyhole is suitable, and what would happen if it needs to become open surgery.
- Go through consent as the parent or carer, including the risks of the specific operation and the anaesthetic, and ask any questions.
- Tell the team about your child's other conditions and all medicines, including any blood thinners.
- Follow the fasting instructions carefully so your child has an empty stomach for the anaesthetic.
- Some operations need bowel preparation beforehand; the team will tell you if this applies.
- Plan for a day case or a short stay, pack comfort items, and arrange for a parent to stay if possible.
- Ask for written aftercare advice and a number to call if you are worried after discharge.
What happens
Your child has a general anaesthetic, so they are asleep and feel nothing. The surgeon makes a small cut, usually at the tummy button, and passes in the laparoscope. The tummy is gently inflated with carbon dioxide gas to make space to see and work.
A few more tiny cuts are made for the instruments, and the operation is carried out while the team watches the magnified view on a screen. How long it takes depends entirely on the operation.
At the end, the gas is let out and the small cuts are closed, often with dissolvable stitches under the skin and skin glue or small dressings. Your child wakes up in recovery before going back to the ward or day-case unit. Sometimes, if keyhole cannot be done safely, the surgeon converts to a larger open cut during the same operation.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Operations or situations where keyhole surgery cannot be done safely or as effectively as open surgery.
- Significant scarring inside the tummy from previous surgery that makes keyhole access risky.
- A child who is too unstable for the gas and positioning that keyhole surgery requires.
- Some emergencies where open surgery gives faster, safer access.
Delay surgery if…
- Your child has an active infection or is acutely unwell (unless the surgery itself is the emergency).
- Blood-thinning or other medicines need adjusting first.
- Fasting instructions for the anaesthetic have not been followed.
- Needed investigations or consent discussions are not yet complete.
Alternatives to discuss
- Open surgery, where keyhole is not suitable or safe.
- Non-surgical (conservative) treatment, where it is a reasonable option for the condition.
- Watchful waiting or monitoring for some conditions, on specialist advice.
- A second opinion or referral to a specialist children's surgical centre.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Smaller cuts and usually smaller scars
- Often less pain after the operation than open surgery
- Often a faster recovery and earlier return to normal activities
- Lower risk of wound infection because the cuts are small
- May reduce the chance of internal scar tissue (adhesions) forming
- Often a shorter hospital stay where the operation allows
Risks & complications
- Pain and bruising around the small cuts
- Shoulder-tip pain in older children from the gas used (usually settles within a day or two)
- Feeling sick after the anaesthetic
- Tiredness for a few days
- Wound infection or a small wound-healing problem
- A feeling of crackling under the skin if a little gas escapes into the tissues (usually settles by itself)
- Bleeding
- Needing to change to open surgery during the operation
- Injury to the bowel, bladder, blood vessels or another organ, which is usually repaired during the same operation
- Gas entering the bloodstream, which is very rare and may need further treatment, especially in very small babies
- A hernia developing later at one of the cut sites
- Serious problems related to the general anaesthetic
The risks depend mainly on which operation your child is having, their age and their other health conditions, rather than on keyhole surgery alone. Very small babies can be more sensitive to the gas used. Ask the surgeon what the specific risks are for your child's operation, how likely a change to open surgery is, and what the scars will look like.
Published figures to discuss
Risk depends mainly on the specific operation, the child's age and their other health conditions, rather than on keyhole surgery itself. Very small babies can be more affected by the gas and positioning. The figures below come from a systematic review of elective keyhole abdominal surgery in infants under one year and should be read as cautious context, not a prediction for an individual child; rates for older, healthier children may be lower.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| A critical event during or within 24 hours of surgery (infants under 1 year) | About 3% (53 of 1,778) in a systematic review | Includes events such as low oxygen levels, low blood pressure or temperature changes; many are temporary and managed by the anaesthetic team. | Safety of elective abdominal laparoscopic surgery in infants (systematic review) – PMCpmc.ncbi.nlm.nih.govPublished figure |
| Temporary drop in oxygen levels during surgery (infants) | Reported up to around 12% in some studies in the review | Managed by the anaesthetist; more relevant to very small babies than older children. | Safety of elective abdominal laparoscopic surgery in infants (systematic review) – PMCpmc.ncbi.nlm.nih.govPublished figure |
| Death (infants under 1 year) | Very rare – about 1 in 1,778 in the review, and not caused by the surgery | The single death was due to a pre-existing serious heart and lung condition, not the operation. | Safety of elective abdominal laparoscopic surgery in infants (systematic review) – PMCpmc.ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery depends on which operation your child has had. In general, keyhole surgery tends to mean less pain and a quicker return to normal activities than the open version, but your team's advice for the specific operation comes first.
- Soreness and bruising around the small cuts for a few days
- Shoulder-tip pain in older children from the gas, easing within a day or two
- Feeling tired and having a reduced appetite for a few days
- Small dressings, skin glue or dissolvable stitches at the cut sites
- Scars that look pink at first and fade over the following months
Aftercare
- Give pain relief as advised, usually paracetamol and sometimes ibuprofen, to keep your child comfortable.
- Keep the small cuts clean and dry, and follow the team's advice on when bathing or showering is allowed (often after about 48 hours).
- Encourage gentle movement and a return to normal eating and drinking as your child feels able.
- Follow the surgeon's advice on returning to sport, swimming, PE and any lifting.
- Watch the cuts for redness, swelling, heat or discharge.
- Keep any follow-up appointment and contact the team if you are worried.
- Leave any skin glue to come off by itself rather than picking at it.
- Pain relief at home (e.g. paracetamol, and ibuprofen if advised)
- Written aftercare instructions and a contact number
- Time off nursery or school arranged (often about a week)
- Loose, comfortable clothing for your child
- A plan for getting home after a day-case or short stay
- Follow-up appointment noted, where one is arranged
- Clear list of warning signs and what to do
Scars and how they heal
Keyhole surgery usually leaves a few small scars, each typically around 0.5–1 cm, often including one at the tummy button where it is well hidden. They are pink at first and usually fade to thin, pale marks over months. If the operation has to be changed to open surgery, there will be one larger scar instead; the surgeon will explain this possibility beforehand.
⚠ Get urgent help if…
- Severe or worsening tummy pain not helped by the usual pain relief
- A tummy that becomes swollen, hard or very tender
- Fever, or any cut becoming hot, very red, swollen or leaking pus
- Bleeding from a cut that does not stop with gentle pressure
- Repeated vomiting, or not drinking and producing very little urine
- Your child becoming very drowsy, breathless or generally unwell
- No bowel movement with a swollen, painful tummy after bowel surgery
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good outcome is that the operation achieves what it was meant to, with small healed cuts and a quicker, more comfortable recovery than the open version would usually give. The success of the operation depends on the condition being treated, not just on the keyhole approach.
Keyhole surgery does not change what the operation can achieve, and it does not remove surgical risk. If the surgeon converts to open surgery, this is a safety decision and does not mean anything has gone wrong. Your team will explain what the operation found and what happens next.
How long the result lasts depends on the specific operation rather than on the use of keyhole surgery. For example, removing the appendix or gallbladder is usually a one-off, while some conditions can come back or need further treatment over time. Your surgeon can explain what to expect for your child's particular operation.
Combining with other procedures
Some operations are combined in one keyhole procedure under the same anaesthetic – for example a diagnostic look that becomes a treatment, or a reflux operation done at the same time as placing a feeding tube. Your surgeon will explain if more than one thing is planned and why.
Follow-up & long-term care
Whether your child needs a follow-up appointment depends on the operation. Many children are reviewed once around 6–8 weeks to check healing and recovery, while some only need to be seen if there is a problem. You should be told who to contact between appointments and what warning signs to look out for.
Revision and secondary surgery reality
- The surgeon may convert to open surgery during the operation for safety; this is planned for and discussed in advance.
- A few operations may need a further procedure later, depending on the condition treated rather than the keyhole approach.
- Occasionally a hernia can form at one of the small cut sites and need repair.
- Some conditions can recur and need further treatment over time.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear pain-relief advice and written instructions for caring for the small cuts.
- A named contact and route to get advice after discharge.
- Clear guidance on returning to school, sport, PE and swimming.
- A follow-up plan where the operation needs one, and warning signs with specific actions.
- Honest explanation of what the operation found and what happens next.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Which operation is being done and how complex it is
- The surgeon's fee and the hospital or theatre facility fee
- The general anaesthetic and anaesthetist's fee
- Length of stay (day case versus an overnight or longer stay)
- Any specialist instruments or devices used
- Follow-up appointments and the policy if a complication or further surgery is needed
- The surgeon's fee and the facility fee
- The general anaesthetic and anaesthetist's fee
- Whether the quote covers a possible change to open surgery
- Length of stay included and the cost of any extra nights
- Follow-up appointments and removal of any stitches
- What happens, and who pays, if there is a complication or readmission
- The cancellation policy
On the NHS? Keyhole surgery is routinely available on the NHS when an operation is needed and the approach is suitable; private care may be used for speed, choice of surgeon or hospital, or a second opinion.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that the surgeon may need to convert to open surgery, and what that would mean.
- Discussing only the benefits of keyhole and not the risks of the specific operation.
- Not making clear that keyhole is a way of operating, not a different or lower-risk operation.
- No written aftercare plan or contact route for problems after discharge.
- Not setting out the warning signs that need urgent attention.
Marketing red flags
- Describing keyhole surgery as scarless, without risks or always better than open surgery.
- Not mentioning the possibility of converting to open surgery.
- Quoting recovery times that ignore which operation is being done.
- Promoting keyhole surgery without a surgeon experienced in that operation in children.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Which operation does my child need, and why is keyhole the recommended approach?
- How likely is it that you would need to change to open surgery, and what would that mean?
- What are the specific risks of this operation for my child?
- How many of these keyhole operations do you do in children?
- How long will recovery take, and when can my child return to school, sport and swimming?
- What warning signs should I watch for at home, and who do I call?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is keyhole surgery safer than open surgery for my child?
Why might the surgeon change to open surgery?
Why does my child have shoulder pain after tummy surgery?
How long will my child need off nursery or school?
Will the scars be obvious?
Is keyhole surgery available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Great Ormond Street Hospital – Keyhole (minimally invasive) surgery NHS – Laparoscopy (keyhole surgery) Royal College of Surgeons of England – Surgery information Safety of elective abdominal laparoscopic surgery in infants (systematic review) – PMC Royal College of Anaesthetists – Anaesthesia and your child
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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