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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