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.
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.”
Endometriosis symptoms can start as early as teen years and are often dismissed by medical professionals. It currently takes an average of 10 years for a woman to get diagnosed. Talking about the condition to increase awareness and educate the medical community is essential to help women manage the disease. Early diagnosis is important to help achieve a better quality of life and maintain the ability to conceive. Although there is no cure, hysterectomy has proven to alleviate symptoms and is often considered as treatment.
“I had a complete laparoscopic hysterectomy. After surgery with Dr. Danilyants I could tell this time was different. Nothing is slowing me down now, it doesn’t seem like I’m juggling a lot of things. I feel jubilant! Now, I can do anything! ” said Dorran, after her surgery with Dr. Natalya Danilyants. You can read her story here.
“In October 2013 I had my last surgery to remove scar tissue and endometriosis excision to prepare for IVF. I look over to my son Landon right now tearing up and smiling. We are beyond blessed with a beautiful healthy baby boy.” said Janelle, who was able to conceive after minimally invasive endometriosis excision. You can read her story here.
Dr. Valinda Nwadike, Maryland based OBGYN, has been referring patients to CIGC for years. When she needed to undergo a hysterectomy herself due to fibroids, she chose the DualPortGYN approach.
“Even though I had these symptoms for a few years (heavy bleeding, anemia, and fatigue), I didn’t want to have to take time off of work. I’m a doctor, I’m a mother, and I run. I’m always very active.”
“At work, a nurse on labor and delivery told me she had a robotic procedure with five incisions. LAVH is four incisions. With DualPortGYN there are only 2 incisions and they are practically invisible now. When I went back to work I was showing my colleagues and they couldn’t believe I was walking in the hallways. It really didn’t feel like I had surgery.”
“I would recommend DualPortGYN to anyone. It is the procedure women deserve. It’s revolutionary. If you laid out all the types of hysterectomy that women can have side by side, why wouldn’t you choose this? I was showing my teeny incisions to my colleagues and they were amazed. They all have the CIGC number now and are making appointments.”
The DualPortGYN approach was developed by Dr. Paul MacKoul MD and Dr. Natalya Danilyants MD to improve surgical outcomes and shorten recovery time for patients. The two 5 MM incisions are virtually invisible once they heal, and women are usually back to work within 1 week. You can hear more about the technique from our patients: Women Talk About DualPortGYN
To discuss your hysterectomy surgery, call 888-SURGERY or contact us online to schedule an appointment.
Years ago Washington DC area radio host Chilli Amar lost her mother and grandmother to ovarian cancer. It’s important that women whose immediate family developed ovarian cancer consider genetic testing, as they are at a higher risk to develop the disease. Chilli was genetically tested for mutations in her genes so she can make an informed decision about her health.
“I wanted my story to be different than my mom’s.” Amar said. “The genetic testing showed that I am positive for the BRCA-2 mutation.”
Chilli decided that preventative surgery is the best path for her to take. She spoke candidly in a Washington Post article about her decision to have a complete hysterectomy, to eliminate the risk of her developing ovarian cancer.
“The first time I ever thought about the surgery was when I read Angelina Jolie’s story in the New York Times and I thought how brave she was. Our stories were similar. Her willingness to be open about her procedures made me go to my doctors and ask if this was an option for me.”
“We put off things because it’s not the right time. When you have such a positive experience, you think ‘Why did I wait?’ My experience at The Center for Innovative GYN Care was incredible. I had a surgery on a Friday morning, and I was off all pain meds in three days, I wasn’t even taking ibuprofen.By the end of the first week, I was able to drive myself on an errand. I was stunned at how fast I had bounced back. You can’t even see the incisions and it’s only been 2 weeks.”
“When you hear minimally invasive, many women don’t really know what that means. I had a consultation with another doctor, and they too had said minimally invasive, 2 incisions. What sets CIGC apart is the placement of the incisions. With DualPortGYN, he doesn’t go through the abdominal muscle. He has a very unique method of performing the surgery. This is why I was driving a week out. I was doing all of those things that other women who had other types of laparoscopic surgery wouldn’t be able to for several weeks.”
“Everything was sent to Pathology, everything is clear and I have nothing to worry about. I have this complete relief because I’m no longer carrying the fear. To have had the knowledge of what I needed to do, as well as the fortune of being able to be proactive, that is relief I can’t put a price tag on. Now, I can focus on other things and truly live my life.” Chilli said.
One of the benefits of recovering quickly after her DualPortGYN hysterectomy was being able to play with her son and pick him up soon after the surgery.
“I didn’t want to have to miss out on time with Donato while I was home. I was doing this so I can be a mom for a long time, so being able to enjoy that time with him soon after surgery was wonderful.”
TALK TO CIGC
To discuss your hysterectomy surgery with a CIGC physician, call 888-SURGERY or contact us online to schedule an appointment. With the advancement of surgical techniques, women shouldn’t still have to undergo open or more invasive hysterectomies, with up to 6-8 weeks recovery time. Patients travel to the Washington DC are from around the country through CIGC’s travel program to benefit from an advanced surgery, with faster recovery. After DualPortGYN hysterectomy, women are usually back to work within 1 week.