For 50 years, ambulatory surgery centers (ASCs)—freestanding, fully licensed facilities for outpatient surgeries—have provided an alternative to hospital-based surgery in the United States. Now, with the uncertainty of the COVID-19 pandemic and many people still concerned about getting the virus, the inherent safety advantages of ASCs over hospitals have helped them become an even more important part of the health care landscape.

 Small and Specialized

Women who need to have elective gynecological surgery but are concerned about COVID-19 can confidently move forward with it at an ASC like those used by The Center for Innovative GYN Care. Among the reasons:

  • ASCs perform only outpatient surgery. An outpatient procedure is one that can be performed in a few hours or less (thus requiring less time under anesthesia) and allows patients to return home the same day.
  • As is the case with CIGC’s GYN-only surgical practice, ASCs usually only treat patients in one or perhaps a few specialty areas (orthopedics or urology, for example) whereas hospitals have among their varied cases patients who already have COVID-19.
  •  ASCs treat far fewer patients in a day and have fewer staff members in the rooms, so there is less risk of being exposed to someone who is asymptomatic (not showing symptoms) yet still capable of transmitting the virus.
  • ASCs have a smaller footprint than hospitals, which makes them easier to sanitize and control for safety measures such as personal protective equipment for surgical staff, mask wearing and proper distancing, screening patients and staff for cold and flu-like symptoms and more.
  • ASCs follow the latest recommendations from the Centers for Disease Control, state departments of health and leading medical associations.

No Waiting

Getting care at an ASC during the pandemic can also be a woman’s safest option because it will likely be her fastest option.

Many hospitals are still trying to catch up on elective surgeries that were canceled during pandemic shutdowns, and the wait to be rescheduled can be long. Prompt care during COVID-19 and a transfer of cases from hospitals to ASCs was recommended by the American College of Surgeons and the American Association of Gynecologic Laparoscopists.

A woman who has fibroidsendometriosis or another GYN condition must not only deal with aggravating symptoms longer, but she also risks her untreated condition getting worse. In just one example, fibroids that grow unchecked can become large enough to cause dangerous bleeding, kidney damage, miscarriage and more.

Today, nearly 6,000 ASCs perform about 35% of all surgeries. And their role in providing safe, rapid care will only continue to expand.

Searching for a safe way to have GYN surgery during COVID-19? Talk to a CIGC patient advocate today.

Paul J. MacKoul, M.D.

Laparoscopic surgery specialist Dr. Paul MacKoul is co-founder of The Center for Innovative GYN Care and CEO of Tower of Surgical Partnersa GYN ASC management company headquartered in Rockville, Maryland. 

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Many patients who visit The Center for Innovative GYN Care (CIGC) for a consultation are seeking a second opinion. In some cases, their symptoms have been dismissed or they haven’t been truly listened to. In others, they’re frustrated with the lack of treatment methods offered to them. In my 30-year career as a surgeon specializing in complex GYN conditions, I notice this happening most often with my African American patients.

Unfortunately, this trend isn’t surprising. The health care industry has a pervasive history of racial disparity. We’re seeing the effects of this divide even more clearly during the COVID-19 health crisis. Black men and women are more likely to develop more severe symptoms and have adverse outcomes of the virus compared to people of other races¹.

In gynecological care, we see a consistent divide in the variety of treatment options offered, necessitating the need for a second opinion.

A Lack of Options in Fibroid Treatment

When it comes to fibroids, as many as 80% of Black women will develop them by age 50. Compared to white women, they are more likely to have fibroids earlier in life and experience more severe symptoms. When they approach their regular physicians with concerns about severe bleeding or pelvic pain, Black women are more likely to be given only two options: “watch and wait” or a full hysterectomy.

It’s just not true that those are the only options available to them. “Watch and wait” is not a treatment, and the impacts of waiting on treatment can be detrimental.

One of the biggest myths about fibroids is that they can shrink over time — this is patently false. Fibroids are noncancerous tumors in the uterus that will grow over time and potentially cause problems with other organs in the pelvis.

Estrogen causes fibroids to grow and will continue to be produced by the ovaries until menopause occurs. Failing to remove fibroids even when they’re small can result in heightened levels of pain and more severe symptoms. For women interested in becoming pregnant, fibroids can make it more difficult to conceive and they increase the risk for a miscarriage or pregnancy loss.

On the other side of the spectrum, a full open hysterectomy is neither the only nor the best option. Treatment methods are just as nuanced as each patient’s health situation, and they need to be customized. At CIGC, we specialize in minimally invasive procedures that put the patient’s health and recovery first. Using the DualPortGYN technique, we are able to fully resolve conditions like fibroids, endometriosis and adenomyosis using two small incisions. Even for advanced stages of disease, our non-robotic techniques are effective and involve only a few weeks of recovery time. Why settle for open or robotic surgery with multiple large incisions and months of recovery when you don’t have to?

The Exclusivity in Endometriosis Care

For endometriosis, the industry has led patients to believe it’s necessary to pay out of pocket for surgery. The truth is that many surgeons don’t accept insurance due to low insurance payments for the condition. This belief has turned endometriosis surgery into an exclusive treatment based on financial status. It leaves out a large population of patients — many of whom are minorities — who may be unable to afford “cash-only” treatment centers. Unfortunately, many “cash-only” endometriosis surgeons charge $10,000 or more for their services.

The bottom line is patients can and should be able to use their insurance to get the care they need. And in a time of financial instability like the one we’re living through now, affordable treatment is more important than ever.

CIGC is a GYN oncology-trained practice, and endometriosis excision plays directly into what a GYN oncologist does. They are trained to specifically treat disease involving the bladder, bowel and ureter, which are all organs commonly impacted by endometriosis. While many GYN surgeons, including some laparoscopic endometriosis specialists, would need to bring in a general surgeon to help treat these complicated cases of endometriosis, CIGC oncology-trained surgeons are already experts who have successfully performed minimally invasive endometriosis excision surgeries — without the assistance of robotics — in thousands of cases. And with their exclusive training, they can often perform endometriosis surgery more effectively and with lower complication rates than teams of surgeons who do not have the pelvic surgery training needed to provide the best possible surgical care.

The Importance of Seeking a Second Opinion

If you or someone you love is struggling with severe symptoms like pelvic pain, heavy bleeding or infertility, find a doctor who will take your symptoms seriously. Your health is too important to settle for a doctor or physician who dismisses your concerns or makes you feel unheard.

All of us at CIGC are ready and waiting to offer you a second opinion. We want you to feel better sooner and get back to your life healthier than ever.



Dr. Paul MacKoul

Dr. Paul J. MacKoul is a laparoscopic GYN surgeon who specializes in minimally invasive surgical techniques. He is a co-founder of The Center for Innovative GYN Care.

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Of the many arenas in our society affected by the COVID-19 pandemic, lack of prompt medical care for severe gynecological conditions stands out as one that has not received the widespread attention it deserves. This is concerning because delaying surgery can have serious ramifications for patients.

It has been months now since many hospitals, physicians’ offices and other health care facilities reopened after mandatory shutdowns issued in many parts of the country, and yet we are still digging out from the backlog of elective surgeries caused by the closures. Some experts estimate it will take a year for surgery volume to return to normal.

Nothing Normal about GYN Symptoms

It is unfortunate that many women’s gynecological symptoms were considered non-essential during shutdowns. It is perhaps even more unfortunate that many women themselves saw, and continue to see, their situations in the same light:

It is unfortunate that many women’s gynecological symptoms were considered non-essential during shutdowns. Perhaps even more unfortunate that many women themselves saw, and continue to see, their situations in the same light: The idea that pain and bleeding are normal is often ingrained in women and passed down through generations. But there is nothing about debilitating pelvic painextreme bleeding or other problems that warrants a delay in treatment, and these problems should never be categorized or stigmatized as such.

If you are experiencing symptoms that are interfering with your normal activities or your ability to enjoy life as you once did, know that your GYN health deserves to be prioritized. In fact, it needs to be: Chronic, untreated GYN conditions and disease can lead to more serious problems.

Find Relief from Fibroids

Complications and Consequences

How might this escalation manifest? A general example is when prolonged bleeding requires a patient to receive a blood transfusion before surgery has even begun: This could trigger the need for a more complex surgical procedure, which could in turn lead to a higher risk of complications or the need for a more invasive procedure with greater pain and a longer recovery time.

Fibroids are another example of why treatment should not be put off. In many cases, waiting too long can cause:

  • Prolonged bleeding and anemia, which is a chronic shortage of red blood cells that can lead to fatigue, headache, weakness and shortness of breath.
  • Kidney damage, if the fibroids grow large enough to press on the ureter and impede urine from draining into the bladder.
  • Miscarriage, if fibroids grow during pregnancy.
  • Bowel or circulatory problems, which can develop when large fibroids take up too much space in the pelvic cavity.

In the case of precancerous or early stage cancer, disease progression may result in the cancer registering at a higher stage upon diagnosis. It also can result in the need for additional therapy after surgery such as radiation or chemotherapy.

ASCs Can Deliver Care Without Delay

Women who are experiencing delays in care from hospital backlogs — or who may be putting off seeking treatment due to worries about COVID-19 exposure in the hospital environment — have an alternative. They can have their surgery with a GYN specialist who is based at an ambulatory surgery center (ASC) like The Center for Innovative GYN Care.

ASCs are freestanding outpatient surgery facilities that are independent from hospital systems, which gives them a higher level of efficiency and control over quality of care. Surgeries can be easily scheduled and performed without long waits, often at less cost to the patient.

ASCs have no ICU, no ER and no inpatient ward. In CIGC’s case, it is dedicated to only gynecological surgeries, whereas hospitals treat patients with everything from injuries to COVID-19. And ASCs have a small, easier-to-control footprint that can be safeguarded from viruses with greater efficiency.

No one knows how long the COVID-19 pandemic will continue to affect hospital-based health care. But even if the virus were to disappear tomorrow, ASCs would continue to be ideal facilities for timely treatment of GYN conditions.

Dr. Paul MacKoul

Paul MacKoul, M.D., is board certified in gynecology and fellowship trained in gynecologic oncology. He is a specialist in the minimally invasive treatment of complex GYN conditions such as fibroids, ovarian masses and endometriosis, as well as early-stage GYN cancer. He is the co-founder of The Center for Innovative GYN Care.

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I see it too often—and it needs to stop.

Female patients, in their mid-30s and early 40s find out there is little to no chance that they are fertile due to the progression of misdiagnosed GYN conditions like endometriosis and fibroids. To make matters worse, both of these conditions can cause persistent and incapacitating pain and bleeding with a major impact on lifestyle and normal daily function.

After going through the rigmarole of being referred out to specialists, having advanced imaging such as MRIs or CT-Scans performed, and being prescribed birth control or narcotics for pain management, many patients come to find that their endometriosis has progressed or their fibroids have grown. And we see this time and time again with thousands of patients who come to our practice for consultations.

Read the full article: “The High Cost of Misdiagnosing Women’s Health Conditions

To schedule a consultation with a CIGC physician, Dr. Natalya Danilyants or Dr. Paul MacKoul, call 888-SURGERY, or reach out online. Patient feedback is available in the Patient Testimonials section of our website, and on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews.

In this recent Hospital and Healthcare Management article, I explore how patients – especially those in rural areas – can benefit from seeking treatment at Ambulatory Surgery Centers (ASCs). Despite the research-proven benefits of ASCs, an overwhelming number of women continue to choose open surgery at a hospital facility with an OB/GYN who only performs surgery 25% of the time. By contrast, choosing to have surgery at an ASC with a GYN specialist that focuses 100% on surgery results in shorter operating times, shorter recovery times, and overall superior outcomes.

Patients need to be their own advocates and thoroughly research alternatives to open surgery with an obstetrics-focused and hospital-bound OB/GYN. Advanced, minimally invasive techniques such as Laparoscopic Myomectomy (LAAM) or Laparoscopic Hysterectomy (DualPortGYN) can be done in an outpatient setting using tiny incisions placed along the mid-line, resulting in fast recovery with minimal pain and scarring.

Read the full article: “ASC Expansion of GYN Surgery to Patients in Rural Areas

To schedule a consultation with a CIGC physician, Dr. Natalya Danilyants or Dr. Paul MacKoul, call 888-SURGERY, or reach out online. Patient feedback is available in the Patient Spotlight section of our website, and on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews.

A recent interview with Authority Magazine writer Christine D. Warner explores advanced surgical techniques developed in response to the lack of innovation and expertise when it comes to minimally invasive GYN surgery. 

As an answer to this problem, I developed new approaches to minimally invasive GYN surgery by applying both known techniques performed in open surgery with new applications in laparoscopy to allow for a better way to perform hysterectomy, myomectomy, and other procedures to optimize outcomes for patients. These procedures had to be safe with much smaller incisions, with a procedural time that was much faster than the OBGYN approach, and resulted in better recovery times and lower cost. The procedures developed included DualPortGYN Hysterectomy and LAAM — Laparoscopic Assisted Abdominal Myomectomy.

Read the full interview with Authority Magazine: “The Future of Healthcare: A New Way to Perform Laparoscopic Surgery with Dr. Paul MacKoul

To schedule a consultation with a CIGC physician Dr. Natalya Danilyants or Dr. Paul MacKoul, call 888-SURGERY, or reach out online. Patient feedback is available in the Patient Spotlight section of our website, and on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews.

Hysterectomy can provide relief from GYN symptoms such as heavy menstrual bleeding, caused by fibroids or adenomyosis. Many women choose to delay surgery due to long recovery times, and not being able to take weeks at a time off work. Hysterectomies are still unnecessarily performed as open by many, with a large incision that can take up to 8 weeks to heel.

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The DualPortGYN approach to hysterectomy surgery uses two 5 mm incisions only, which leads to a much faster recovery for the patient. Most women go back to work in 1 week. This technique was developed by CIGC founders Natalya Danilyants and Paul MacKoul to improve surgical outcomes for women.

“I would recommend this procedure to any woman who needs hysterectomy. It’s safer, quicker, better, in any way.” said Heidi, CIGC patient. Discover the CIGC difference. Learn about the advanced DualPortGYN technique for laparoscopic hysterectomy. 

Hear from our patients: Looking For A Top Hysterectomy Surgery: Women Talk About DualPortGYN

To schedule a consultation with a CIGC physician, call 888-SURGERY, or reach out online. Patient feedback is available in the Patient Spotlight section of our website, and on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews.

April is adenomyosis awareness month. One of the lesser known GYN conditions, adenomyosis, can cause severe pain and bleeding with the menstrual cycle. After attempts at conservative management with medicine and minor temporizing procedures, if the symptoms continue and a woman has completed child bearing, then hysterectomy can be an option. To date, hysterectomy is the only known cure for adenomyosis. Additional information about the disease is available in the Adenomyosis section on the CIGC website, and in this recent blog: Extremely Painful Periods: Adenomyosis Awareness Month.


At The Center for Innovative GYN Care, minimally invasive hysterectomy is performed as definitive adenomyosis treatment, and women typically recover from surgery in 1 week. The DualPortGYN technique used for hyserectomy, innovated by CIGC founders Dr. Natalya Danilyants and Dr. Paul MacKoul, is an advanced surgical technique using only 2 small incisions, allowing for a much faster recovery, with less pain. CIGC adenomyosis patients have shared their journey struggling with symptoms, and finding relief. You can read their stories here:

Kia’s Adenomyosis Pain Felt Like Being Stabbed Every Month
Tiffany D. Needed A Specialist For Multiple GYN Conditions

Patient feedback is also available online, on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews. To schedule a consultation with a CIGC physician, call 888-SURGERY or reach out online. Patients residing outside the Washington, DC area, can look into our travel program.


Fibroids affect up to 80% of all women, and many struggle with symptoms for years before seeking surgical treatment. Minimally invasive removal of fibroids can relieve symptoms such as heavy menstrual bleeding and pelvic pain, and women get back to their normal lives in days vs weeks.

Minimally invasive myomectomy is a fertility sparing procedure.  At The Center for Innovative GYN Care, advanced surgical specialists use the LAAM technique to remove fibroids with 2 small incisions.  The LAAM procedure is one of the least invasive and most thorough uterus sparing surgeries for fibroids, and it is only performed on patients who are able to retain fertility. When fertility is no longer a viable option (1% or less), and fibroid symptoms are severe, a myomectomy is not recommended.

Hysterectomy is definitive treatment of fibroids and it is performed at CIGC with the DualPortGYN technique. Women generally recover in 1 week after DualPortGYN hysterectomy, and only two 5 mm incisions are used. A minimally invasive hysterectomy achieves permanent relief from symptoms, as opposed to myomectomy, where additional surgery may be necessary if fibroids recur.

CIGC patient feedback is available in these blogs:

Women Talk About LAAM: A Safer & Better Myomectomy
Looking For A Top Hysterectomy Surgery: Women Talk About DualPortGYN

You can also find patient stories on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews | Dr. Rupen Baxi Reviews.

To schedule an appointment with a fibroid specialist Dr. Natalya Danilyants, Dr. Paul MacKoul or Dr. Rupen Baxi, call 888-SURGERY or reach out online.

A myomectomy is a fertility-sparing procedure, designed to surgically remove fibroids. When fibroids become large, they can distort the uterus, making it harder for women to conceive and carry to term. Early treatment is important in order to prevent further issues, and seeking the help of a specialist is essential.


Thorough removal of fibroids is possible for many patients. A myomectomy is not definitive treatment as fibroids can still return. The only definitive treatment is hysterectomy. A minimally invasive myomectomy relieves symptoms such as heavy menstrual bleeding, and prepares the uterus for pregnancy. With CIGC’s LAAM approach, laparoscopic myomectomy is performed using 2 small incisions. Women recover in less than 2 weeks and many are able to conceive naturally after surgery. In order to achieve a healthy pregnancy, women should wait at least 3 months after surgery before pursuing fertility options as it is essential for the uterus to be completely healed.

Learn more about myomectomy recovery and why choose a laparoscopic specialist to perform your surgery, in this recent CIGC blog: LAPAROSCOPIC MYOMECTOMY RECOVERY & WHAT TO EXPECT

Hear from other women, read LAAM patient stories:

Rashetta’s Story: Minimally Invasive Removal of Large Fibroids is Possible
Aziza’s Story: 25 Fibroids Removed With Advanced Laparoscopic Myomectomy
Leslie’s Story: Finding The Right Treatment For Fibroids

CIGC patient feedback is also available online, on doctor review sites: Dr. Natalya Danilyants Reviews | Dr. Paul MacKoul Reviews | Dr. Rupen Baxi Reviews.

To schedule a consultation with Dr. Natalya Danilyants, Dr. Paul MacKoul or Dr. Rupen Baxi, call 888-SURGERY or contact us online. Women residing outside the Washington DC area, looking for advanced options for GYN care, can read about CIGC’s travel program.