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.
Brittany (30) from Herndon, Virginia had been trying to conceive for four years before coming to CIGC for minimally invasive cyst removal. During surgery, it was discovered she had also been suffering from endometriosis and bowel adhesions. Endometriosis is known to cause infertility as endometrial tissue can affect the ovaries and quality of eggs, and can create toxicity in the lining. After GYN surgery, Brittany got pregnant within a month.
“My daughter is 3 years old now. She is happy, healthy and perfect. It brings tears to my eyes just thinking about the carefulness of the surgery, and being able to keep my ovary and returning to normal within days. I didn’t think that I would end up keeping my ovary and didn’t know if I could ever get pregnant on my own. When that test came back positive my world changed all for the better.” Brittany said.
Endometriosis affects millions of women, and for many it takes years to get diagnosed. The primary symptom of endometriosis is intense pelvic pain with the menstrual cycle, which can be constant, or it can progress. Women who suffer with severe symptoms every month have a hard time at home, work or school, and they are often seen as unreliable. It can become difficult to explain to teachers or bosses why you repeatedly need time off for a few days each month.
Endometriosis pain is often confused with regular menstrual cramping and symptoms are dismissed in doctor’s offices. The longer it takes to get a diagnosis & treatment, the more damage can occur. Endometriosis causes inflammation and scarring which primarily affects the pelvis, but lesions can spread to other areas of the body. It takes an experienced specialist to recognize the signs and to deliver a proper diagnosis. Thorough excision of all instances of endometriosis is essential to alleviate symptoms and achieve long-term relief.
It is fueled by estrogen.
It primarily creates lesions within the pelvic cavity, but has also been found in other areas of the body like the abdominal cavity, the lungs and the brain.
Endometriosis can be deep within the tissue and it can affect nerves.
Lesions must be thoroughly removed through excision to alleviate symptoms.
Endometriosis can cause pelvic adhesions and cysts to develop.
DIAGNOSIS & TREATMENT
Why some women develop endometriosis and others do not is a mystery. That makes it harder for general medical practitioners to diagnose the condition early, which is important in order to minimize the damage to the reproductive system. Endometriosis specialists have a more complete understanding of the disease, the symptoms, and the damage it can cause.
The DualPortGYN approach was developed by CIGC minimally invasive GYN surgeonsNatalya Danilyants MD and Paul MacKoul MD and it uses just two 5 MM incisions. The surgeon who operates is able to see the entire pelvic cavity in order to achieve thorough removal so all instances of endometriosis are removed. The incisions are located in the midline of the abdomen and pelvis, avoiding the muscles, which reduces post-operative pain. Women go home the same day and are usually back to work within 1 week after DualPortGYN surgery.
Women struggling with fibroids often face challenges when they try to become pregnant. Fibroids can make conception difficult, they can cause miscarriages and preterm labor. Many times they have waited too long and hysterectomy is the only option for treatment as there is no uterus left to salvage. It’s important that women are aware of the risks and seek treatment early, before extensive damage occurs.
LOOKING FOR THE BEST TREATMENT FOR FIBROIDS
A popular approach is to “watch and wait”. This is an outdated method as fibroids can grow very fast and it becomes harder to repair and preserve the uterus for fertility. Fibroids can obstruct fallopian tubes or the cervix making it harder for women to get pregnant. Fibroids that grow within the uterine lining, or develop within the muscle, can distort the uterine cavity. Removal of fibroids that distort the uterus dramatically reduces the risk of miscarriage.
Some medical professionals recommend uterine fibroid embolization, which can be appealing to women due to the non-invasive nature of the approach. This procedure however has limitations. In younger patients, long-term control is limited: additional fibroids can grow or the fibroid that was embolized could re-establish a blood supply. Embolization can also affect implantation of the embryo into the lining of the uterus where the baby grows. Read more in this WTOP article.
When it comes to surgical treatment, it should be performed by a laparoscopic specialist, with minimally invasive approach. With advanced surgical techniques like LAAM myomectomy, fibroids any number and size can be removed laparoscopically, in outpatient settings, and recovery is less than 2 weeks. The LAAM technique allows surgeons to feel the fibroids, even those localized deep in the muscle of the uterus, so they can be removed. Thorough removal is important to achieve long-term relief from symptoms and to increase the chances of a healthy pregnancy.
CIGC PATIENTS TALK ABOUT THEIR JOURNEY WITH FIBROIDS
CIGC patient Tonya suffered for years from fibroids and adenomyosis, and her symptoms got progressively worse.
“One month, I was hemorrhaging, and then all of a sudden, the bleeding stopped but the pain didn’t. I remember being in the house, and I was very weak. I was very anemic. I walked across the street to a Starbucks, I thought I needed something to eat. As soon as I was in Starbucks, I had to sit down, because I was feeling really dizzy, and really shaky. I went next door to an urgent care and they had to put me into a wheelchair because I couldn’t stand any longer. After all of the tests, they determined I was dehydrated from losing so much blood.”