Open surgery requires a big cut to be made, and the surgeon has to reach into your body to cut the parts out. For keyhole surgery, incisions are made and instruments reach into your body to make the cuts rather than a surgeon’s hands. In that sense, keyhole surgery is a much harder surgery to perform.
But the main thing is to make sure that we get rid of all the cancer. So technically the risk of keyhole surgery depends on the difficulty in finding the angle to cut the stomach out and doing the surgery in a confined space compared to open surgery. Open surgery is easier, I’ve been doing it for a long time.
Keyhole surgery is harder and takes longer, probably an extra 1-2 hours. So the risk is that the surgery is slightly longer for the patient. But bear in mind that open surgery requires a big cut, so the overall risk is still lower for keyhole surgery. If you get someone who’s not very experienced in doing keyhole surgery then that’s where the concern is.
That’s when the practice and experience come into play -- in the sense that big cancers can still be operated on with keyhole surgery, that’s the main advantage. Blood loss is lower, recovery is much faster, the risk of other complications such as infections are lower.