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.
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.
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.
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.
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.
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:
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:
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.
The Center for Innovative GYN Care advanced surgical specialists use only minimally invasive techniques for fibroid removal. A laparoscopic approach in GYN surgery, with smaller and fewer incisions, helps patients recover faster and become mobile sooner.
When you are limited in mobility for an extended period of time, more than two weeks, muscles begin to decondition, or detrain. Walking promotes the flow of oxygen throughout the body, and maintains normal breathing function. Gastrointestinal and urinary tract function are improved, and with improved blood flow, wounds heal faster. Every patient’s recovery is different and should be monitored by a physician, but gradual and measured increase in movement and activity can help prevent prolonged recovery times.
CIGC’s advanced LAAM technique for laparoscopic fibroid removal provides such amazing results, many women choose to travel from out of state for surgery. With LAAM, our patients are able to recover faster, with less pain, and get back to work in less than 2 weeks. For many of them, the only options back home are more invasive open or robotic surgeries.
Ruchika S. from Rhode Island, had a very large fibroid, which did not cause any symptoms except making her stomach look big. She knew it had to be taken out. Ruchika researched her options and made the decision to travel for LAAM surgery.
DISCOVERING THE FIBROID
“Except for my stomach getting really big, I didn’t have any symptoms of fibroids at all,” Ruchika said. “No pain, no excessive bleeding. I’ve always had a relatively flat stomach, and I just turned 38. I remember back in January last year, I was working out, and not eating very much, and yet my stomach was getting bigger. I travel out of the country a couple of times a month. I run the international business for a medical device company. The crazy lifestyle that goes with that I just assumed it was part of it. I thought ‘Well, I’m getting older.’ I was resigning myself to it. Everything else was fine, except my stomach.”
“I’ve never been very good about doing the annual check-up. I finally went to see a regular gynecologist for a check-up. She checked my stomach and said ‘Well, what do we have here?’ I said what?” and she said ‘You’re pregnant.’ I’m pretty sure I’m not pregnant. I’ve had my period. ‘You’re four-to-five months pregnant.’ Obviously, I wasn’t pregnant, but she started doing tests and the ultrasound didn’t show anything. Then I had an MRI. The MRI showed that I had one gigantic fibroid. When I got my MRI results, I saw what it was and realized this needs to be taken out.”
SEARCHING FOR THE BEST FIBROID TREATMENT OPTION
Ruchika thoroughly researched options for fibroid removal. She learned embolization wasn’t possible due to the size, and most medical professionals recommended open surgery as the only option.
“During all of my research, I came across Dr. Paul MacKoul. I started doing more research on LAAM. Everyone in Rhode Island was saying I would have to have an open procedure. I was worried about my January schedule for travel and Dr. MacKoul was able to fit me in the week before Christmas. Timing wise it was great.”
The advanced LAAM technique was developed by CIGC founders Natalya Danilyants MD and Paul MacKoul MD to provide superior surgical results, and get women back on their feet faster. LAAM is only performed on patients who are able to retain fertility and has no limit for fibroid size, number, or location. CIGC surgeons use only two small incisions for this approach, and recovery is less than 2 weeks.
TRAVELING TO WASHINGTON DC FOR LAAM MYOMECTOMY
“Getting on a plane to go anywhere is not that a big deal for me at all. I live on the East Coast, my boyfriend lives on the West and my brother lives in New York, so regardless of where I had the surgery, they were going to have to travel to be with me. I was looking for the best surgeon. The one thing I have learned is that choosing the right surgeon matters.”
“I flew to DC, got the surgery done on Tuesday and was back in Rhode Island on Thursday. By Saturday I was fine to be on my own. I wasn’t up for going out and doing much for Christmas, but I really enjoyed being at home in my own space which I never get to do. I was off from work until New Year’s, and I had meetings in Europe and China the following week, so I was on a plane 2 and a half weeks after the surgery, and back at the gym. I don’t even think about it anymore. I have a flat stomach now!”
RECOVERY AFTER LAAM SURGERY
Ruchika’s fibroid was 1700 grams (close to 4 lbs). A normal uterus is 70 grams. Due to the size, most surgeons are only able to perform an open procedure, with 6-8 weeks recovery time. With LAAM, minimally invasive removal of a fibroid this size is possible.
“I was back to myself in a week and a half, and that was important to me. After two weeks I was back at work. Compared to the alternative, I’m so grateful. Everything is back to normal now. I’ve been working out. I went ice climbing two weekends ago, and I’m traveling for my normal insane life. Three weeks after the surgery I was running 7 to 8 kilometers.”
“Both my brother and boyfriend were able to take time off to be with me. Tuesday after the surgery I was a little out of it, but by Wednesday morning I was fine. Thursday evening, we all flew back to Rhode Island. I didn’t need any of the narcotics after the first day. I was on Advil the rest of the time.”
“Recovering at home was nice. My support system was there for me regardless of where I was. Not having to be in the hospital was nice. Having the surgery didn’t impact my work life at all. I took the last two weeks of the year off, and everyone else was taking vacation, so the timing was perfect for me. The whole experience was really good. ”
When it comes to a fibroid removal procedure, the surgical approach plays a great role in the patient’s recovery. The ability to perform thorough removal with smaller and fewer incisions leads to less complications and post-operative pain. Placement of incisions through the midline of the abdomen, bypassing the lateral abdominal muscles, allows for a safer surgery and a faster recovery.
CIGC surgeons developed the LAAM technique for myomectomy and the DualPortGYN approach for hysterectomy as definitive fibroid removal, to improve surgical outcomes. The use of the smallest incisions possible, including ultra-minilaparotomy, provides remarkable surgical results.
“Ultra-minilaparotomy is considered to be cosmetically superior as the incision is made along the natural cleavage of the skin folds. It is made in the midline and is very small, therefore, sparing the nerves and blood vessels on the lateral edges of the abdomen. It combines the best advantages of open and laparoscopic techniques.” said CIGC’s Rupen Baxi MD.
PATIENT TESTIMONIALS: RECOVERY AFTER ADVANCED FIBROID REMOVAL
CIGC patient and Maryland-based OBGYN, Dr. Valinda Nwadike, chose to undergo DualPortGYN hysterectomy as definitive fibroid treatment. Three days after her surgery, she was delivering babies.
“Dr. Natalya Danilyants advised me to take it easy for a week. The next day my son had a doctor’s appointment at 4PM and I felt well enough to sit with him in the waiting room, and then I went to dinner. Three days after the surgery, I was scheduled to work a 24 hour shift at the hospital, and delivered three babies. I was a little tired, but it didn’t slow me down. The next day, my husband and I drove to North Carolina. My husband drove, and I felt fine during the ride. I was told not to run for a couple of weeks, but I was fine doing boot camp a week later. I didn’t need any narcotics, I didn’t have any bleeding.” Dr. Nwadike said. Her full story is available here.
Lindsay (33) chose to travel from Dallas, TX for advanced laparoscopic myomectomy with the LAAM technique. She went through extensive research to find the option with the best possible outcome.
“My surgery was on a Thursday and I just flew in the day before. I didn’t know what to expect, I thought I was going to be in crazy pain at least for the weekend. But the next day, I woke up, and I felt great. We actually went site-seeing. That was amazing, the day after surgery I was up and moving. I used pain killers for about 3 nights. By the day I got back to Dallas, I was off painkillers. There wasn’t really pain, I just felt sore. It was completely different than I expected.” Lindsay said. You can read her story here.
TALK TO US ABOUT YOUR OPTIONS
A minimally invasive approach to fibroid removal is in the patient’s best interest. Many women residing outside the DC area choose to travel to CIGC for advanced GYN surgery as these procedures allow them to recover faster and to get back to their lives sooner. Patients recover in less than 2 weeks after LAAM myomectomy and within 1 week after DualPortGYN hysterectomy.