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.
CIGC’s hysterectomy patient from Maryland – Tracy J. – was struggling with fibroids that caused severe GYN symptoms. Tracy had not been sick before and she first ignored the signs when she first experienced pain and discomfort back in 2012. As years passed, she became extremely anemic due to very heavy bleeding and developed a small embolism in her leg that could have been fatal.
“The day I had to call my family and tell them that I was in the hospital with a blood clot, the hospital staff kept telling them that I could have died, which didn’t help their fears. I had an 8-week course of iron infusions. I had a baseline of 5. It’s supposed to be 12. I realized after that I had adapted to the amount of iron in my system.” Tracy said.
A friend spoke to Tracy about us years ago and she decided to reach out and seek surgical treatment when her symptoms got truly severe.
“At this point, I was having this horrendous bleeding, even though the clotting was managed, the bleeding was out of control and my stomach was always swollen. I now had a new job and great insurance, so I called The Center for Innovative GYN Care.”
“After the surgery, I am a one-woman marketing team, a grassroots campaign manager. I took a stack of business cards and I give them to people who I know have GYN problems. I’m happy to be here. I don’t believe in wasting a day. I’ve lost friends at young ages and have known people who have lived into their hundreds. I want to be one who lives a long life.”
Regina R. from Los Angeles, CA was diagnosed with fibroids years ago and was told she needs to have a hysterectomy. At the time, she was not ready to consider this procedure and decided to wait. She actually found a doctor in Beverly Hills, CA who said he could shrink fibroids with a tool that he had invented. When Regina went to see this doctor, he raised several red flags for her.
“He said ‘I can’t do the procedure on you, because there is literally no room in your abdomen to even put the tool in there. Your uterus is the size of 30 week pregnancy. You should have back pain, acid reflux.’ and he was looking at me in disbelief. That freaked me out. He said ‘You really need to take care of this. You can damage your kidneys. Your organs don’t have any room. The fibroids have filled in whatever space was left.’” Regina recounted.
“I drove home so upset. All of a sudden I was feeling the fibroid, whereas before this I hadn’t even noticed it. I do yoga 4-5 times per week. I was doing backbends and running around. I do power yoga for an hour and a half every day. I was doing 50 sit-ups at one point, and doing arm balances and headstands. I’ve been doing it for 6 years and I’m pretty advanced.”
“Once I got home I knew I had to take care of this. The trauma of open surgery wasn’t something I wasn’t willing to go through, especially still not having any noticeable symptoms, except that I didn’t have a flat stomach. It was pure vanity that started the whole thing. I still kept feeling like I didn’t need to do this, but at the same time I knew I did.”
CHOOSING TO TRAVEL FOR MINIMALLY INVASIVE HYSTERECTOMY
Regina’s doctor was only able to perform an open surgery, with 4-5 days in the hospital and 8 weeks recovery time. She researched her options online hoping to find a better approach and discovered CIGC.
“Reading all of the blogs and hearing these women’s testimonials, I realized I could do that. There is the expense of flying and hotel, but in the end it’s my body. My only options were open surgery here or flying to Washington, D.C. It was a no-brainer. After reading every person’s comments and blogs, and procedures, and looking up reviews on both doctors, I felt comfortable enough to say ‘I’m doing it.’ Mentally, I was now feeling the fibroid. I was ready to get it out of me and move on.” Regina said.
“I have a friend who is a gynecologist, who just told me to have the open surgery in LA. She said there was no way they could remove a uterus that big laparoscopically. My husband is good friends with her husband, and he was at their house prior to it. She kept saying ‘There’s absolutely no way they can do that. Don’t let her go!’ My husband stood firm saying ‘She’s done her research, I trust her and back her up.’”
LAPAROSCOPIC HYSTERECTOMY WITH DUALPORTGYN AT CIGC
With the DualPortGYN technique, minimally invasive hysterectomy can be performed for a uterus up to 20 pounds. Because of the minimally invasive approach, only two 5 MM incisions, recovery is minimal – 7 days. DualPortGYN hysterectomies use a specialized technique called retroperitoneal dissection that helps control blood loss and maps the pelvic cavity so the surgeon is able to fully visualize the pelvis.
“Open surgery was never even discussed. He does this surgery all the time, and it was business as usual. The phone consultation was very direct. I wanted someone straightforward for whom this kind of surgery is no big deal. I want to be one of a thousand, not one of a few.”
“The surgery was complex. When Dr. MacKoul came back in to talk to me he said that the ureter was wrapped around the uterus on both sides and some of the other organs were on top of it. I definitely needed to take care of it. It was remarkable. I obviously had a stomach, but I didn’t realize that the fibroid was going past my hipbone or my rib cage. It was the shape of a giant jellybean. After the surgery, my stomach is totally flat now.”
HAPPY WITH HER DECISION TO TRAVEL FOR SURGERY
The decision to travel for surgery is not an easy one to make, especially when family and friends have their doubts and try to change your mind. Regina however felt confident in her choice and went all the way. She recovered quickly after her laparoscopic hysterectomy, with very limited pain.
“I’ve been taking it easy, I’m basically back to normal, I didn’t really take any pain medication except to go to sleep the first couple of nights home. I’m totally feeling fine! People come to see me and it’s so weird because you don’t look like you’ve had surgery! I keep forgetting that I’ve had major surgery, you feel the incision a little bit, but it’s not anything that keeps me from doing anything.”
“Coming from a large city in LA where you can find an expert on everything, and having family and friends not understanding why I was going literally across the country for this procedure, my family especially was very uneasy. We are used to having everything within driving distance and even when I explained it to them, they couldn’t understand.”
“As the time got closer, it was a mental thing, I hadn’t met the doctor in person, I haven’t been to this hospital before, of course you get nervous. However, from the time that I called, to get information, to get my insurance approved, to speaking to the doctor, to having Emily call me and schedule the surgery, to the follow-ups for the lab work I needed, to the email communication, everything was so professional and so perfect. I didn’t have to worry about thinking about anything. The only thing I had to worry about was getting a flight and getting a hotel room.”
BOOK A CONSULT
If you would like to discuss your DualPortGYN hysterectomy with a CIGC specialist Dr. Paul J. MacKoul or Dr. Natalya Danilyants MD, call 888-SURGERY or contact us online. The Center for Innovative GYN Care has offices in Bethesda, MD, Annapolis, MD and Reston, VA. Patients who reside outside the Washington DC area travel to CIGC through our travel program.
Q. What is the recovery time after DualPortGYN procedures and what are common complications?
A. DualPortGYN gives you the fastest recovery possible. We’ve done thousands of these cases including a very large study in a local hospital which shows that the recovery time on average is 7 days back to work. That can be for a uterus the size of a grapefruit to a uterus the size of a watermelon. Recovery is typically 7 days and it can be 10 days with more extensive procedures. When you talk about robotic surgery it’s 2-4 weeks and with open it’s 6-8 weeks. The complication rate is the lowest possible compared to the other procedures.
“I had fibroids for 2 years and I had a GYN who was very laid back about them. I was trying to conceive. After about a year, the fibroids were clearly a problem. I switched doctors, but that doctor had the exact opposite advice, saying I needed surgery right away, I was infertile, and she was really harsh about it. She said I would need an open procedure, and that if I wanted to get pregnant down the line I would need to take 6-8 weeks off.” said Anne from Omaha, NE.
Anne had been dealing with fibroids for several years, and they were affecting her ability to get pregnant. She could not find the options she was looking for close to home, and decided to research fibroid removal procedures online. She found that a minimally invasive myomectomy for fibroids of any number and size, is possible at The Center for Innovative GYN Care.
Anne decided to travel to the Washington DC area for the innovative LAAM procedure developed by CIGC’s Paul MacKoul MD and Natalya Danilyants MD. She wondered if she will be a candidate as she had 13 fibroids to be removed. Anne had a successful laparoscopic myomectomy and was back to normal within days.
“After 10 days I was back to normal. No complications, no severe pain. I was working out after 2 weeks. I have my abs back now. I didn’t realize how uncomfortable I was until after I had the surgery. I literally feel like a concrete block has been removed from my abdominal area. I’m back to normal, but better than normal used to be.”
Pelvic adhesions (scar tissue) are usually caused by multiple pelvic/abdominal surgeries, infection, or endometriosis. Scar tissue can grow between two organs in the pelvic area making them stick together. These pelvic adhesions can occur around the bladder, bowel, ureter, uterus and ovaries. They are also more common after open surgery than laparoscopic surgery.
This scar tissue can be completely asymptomatic and not cause any problems. However, when it causes infertility, pain or gastrointestinal problems, such as bloating and constipation, surgical resection should be considered. Thorough resection of pelvic adhesions is essential in order to relieve pain and avoid new adhesions to form.
Pelvic adhesions can involve different organs:
Bladder adhesions: these usually form after cesarean delivery. Multiple cesarean deliveries lead to dense adhesions between the bladder and the uterus. In order to avoid recurrent adhesions and pain, removal of the uterus through laparoscopic hysterectomy is recommended.
Bowel adhesions: these form after abdominal and pelvic surgeries like myomectomies, or after severe pelvic infection from a ruptured appendix or bowel injury. Careful dissection of the bowel with special scissors is required, and this should only be performed by an experienced surgeon.
Endometriosis adhesions: these can form as a result of extensive or longstanding endometriosis and can cause pain and infertility. These adhesions are usually very dense and involve important structures such as the rectum, large pelvic vessels, and ureters, they can be very difficult to resect. If the patient does not wish to preserve fertility, removal of the uterus with or without the ovaries should be considered.
Ureteral adhesions: these are adhesions around the tubes that connect the kidneys to the bladder. They are found in severe endometriosis. In rare cases, the extent of damage to the ureter from endometriosis requires ureteral reimplantation.
Resection of pelvic adhesions can be a very complicated procedure. In the hands of an unexperienced surgeon, it can result in injury to surrounding organs and a higher risk of conversion to open surgery. Laparoscopic resection of adhesions is the preferred method because it is safer and leads to less pain and faster recovery for the patient. Patients with severe endometriosis should seek care from a surgeon that is experienced in advanced laparoscopic procedures. Gentle handling of the tissue, minimal blood loss, and minimally invasive surgery decrease the risk of adhesion formation.
The Center for Innovative GYN Care has offices in Bethesda, MD, Annapolis, MD and Reston, VA. Patients who reside outside the Washington DC area travel to CIGC for minimally invasive GYN surgery through our travel program.
Endometriosis affects over 5 million women in the US alone, but it is still greatly misunderstood by patients and doctors. There is a need for better medical training in recognizing the symptoms and providing treatment that is thorough and efficient. Often is it up to the patient to be their own best advocate and keep looking for answers, and this can be a long and painful journey.
Addressing symptoms early is essential when it comes to this debilitating disease. Endometriosis has no cure, but it can be managed in order to achieve a better quality of life, and the ability to conceive. Take a look at these helpful facts to learn about the symptoms, and options for diagnosis and treatment.
Endometriosis symptoms include pelvic pain, heavy bleeding, bloating and fatigue, difficulty urinating or having a bowel movement, and even difficulty getting pregnant or carrying a pregnancy to term.
There are various stages for endometriosis, from small deposits of endometriosis to the entire pelvis being stuck together. The stage though is not directly correlated with the pain. What is important is to diagnose and remove endometriosis, and then either treat with medical suppression, or try to become pregnant if the patient is looking to conceive.
Endometriotic lesions are very small and they can’t be seen with imaging studies, such as ultrasound or CT scan. Exceptions to this are if endometriotic cysts are present in the ovaries.
A definitive diagnosis can only be made with diagnostic laparoscopy. This procedure allows for a small thin camera to be inserted into the abdomen, where the entire pelvis can be inspected and suspicious lesions can be resected for a diagnosis.
There is no cure for endometriosis, but it can be managed medically, surgically, or with a combination of both.
Endometriosis excision preserves the uterus, tubes & ovaries for women who wish to maintain fertility, or who have milder disease. Complete removal of all instances of endometriosis is essential for long-term relief, and medical management can extend the length of pain control.
A minimally invasive hysterectomy with removal of both ovaries has been shown to alleviate many symptoms, particularly if the endometriosis is localized to the uterus. This is only effective if resection of endometriosis is performed simultaneously and all instances of endometriosis are removed.
Pelvic adhesions are common with endometriosis patients. If they are removed incorrectly, they can reform and create additional pain. Unless seen by a specialist first, it is very common for endometriosis patients to have increased pain from surgery performed incorrectly.
Many of our patients travel from out-of-town and from out-of-country for advanced minimally invasive GYN surgery at CIGC. Women who don’t have minimally invasive treatment options for their GYN condition closer to home can now benefit from CIGC’s groundbreaking techniques through our travel program. Innovative procedures like DualPortGYN and LAAM were developed by Paul MacKoul and Natalya Danilyants to improve surgical outcomes for patients and to help them recover faster.
GYN surgery for complex conditions like large fibroids and extensive endometriosis is now possible with only 2 small incisions and recovery in less than 2 weeks. Many times women are recommended open or robotic surgery and this is not longer necessary with advanced laparoscopic techniques.
We want to make traveling for GYN surgery from long distances as seamless as possible. Read about CIGC’s travel program and contact us online or at 888-SURGERY to book an appointment. CIGC has offices in Rockville, MD, Annapolis, MD and Reston VA.
With up to 80% of women struggling with fibroid symptoms, many come to CIGC looking for a better fibroid removal surgery. When it comes to surgical treatment, many procedures are still performed unnecessarily as open, and untrained specialists recommend hysterectomy when it is unnecessary. It’s important for women to do their research and get to know their options so they can choose a safer, less invasive surgery.
“No large incision! I have to look for it. I was back to work in 2 weeks. I had 17 fibroids removed. Three of them were really big. I felt excavated, all of the junk removed. It feels so liberating to have them all out!” said Azundai about her procedure with Dr. Paul J. MacKoul. You can read her full story here.
“I had heard and seen what other women had gone through for fibroid removal. Their recoveries were much longer. I really appreciated the small incisions. I compared what I experienced to other women when I got home, and they were amazed.” said Jenny, who traveled from Wisconsin to Maryland for her LAAM procedure with Natalya Danilyants MD. You can read her full story here.
Many CIGC patients struggling to conceive have found that GYN surgery for conditions like fibroids or endometriosis can often clear the path to motherhood. Fibroids affect up to 80% of women and they can interfere with a woman’s ability to conceive and carry to term. Endometriosis affects more than 5 million women in the U.S. and it is the leading cause of female infertility. Fertility investments can be expensive and it is important to diagnose and treat GYN conditions early in order to prevent future damage.
Azundai, LAAM patient at CIGC, had been diagnosed with fibroids back in 2012, but was advised to watch and wait. It’s important to note this is an outdated approach and it is not effective as fibroids can grow and cause problems if left untreated. Azundai waited for three and a half years and then in 2015, decided to begin her search for the best fibroid surgery.
Having confidence in the GYN specialist who will perform your fibroid removal procedure is a very important part of your care. You need to be able to trust that your doctor will address your concerns and that the outcome of the surgery will be the best possible one. While many doctors specialize in OB/GYN care, they are not fully trained on minimally invasive GYN surgery for complex conditions. Getting a second opinion can be essential.
RESEARCHING YOUR OPTIONS FOR FIBROID TREATMENT
Azundai researched her options online, trying to find the right approach for her. There are new techniques to treat fibroids that are non-invasive, but they can affect fertility, and fibroids can continue to grow if they are not removed.
“The more I read online, the more scared I got. I read that fibroids could be treated with ultrasound, but that doesn’t cure them. I was shot down by one doctor because I had more than 4 fibroids. I thought about hormone therapy. Confused and frustrated, I cried out and prayed earnestly to God for the right answer to my healing. Putting my fear aside, I decided to keep faith and hope for a successful surgical approach and outcome. I finally started looking at surgeons and found one doctor that specialized in myomectomies, but they were open procedures.I thought about going to Chicago to get radiofrequency ablation, but above all of my requirements I wanted to maintain my fertility. I didn’t want to have a hysterectomy. I wanted to be able to have a chance to be the mom I know I can be.” Azundai said.
“I was already scheduled for the open myomectomy. My new boss introduced me to another of my colleagues who had just had a myomectomy. Once I talked to this colleague, she told me about The Center for Innovative GYN Care, and Dr. Paul J. MacKoul and Dr. Natalya E. Danilyants, and she gave me the website. I found that the CIGC website’s information answered my questions and eased my fear of having surgery, which was something I never had to have in my 32 years of life.”
Azundai came to us and was scheduled to have a minimally invasive LAAM myomectomy. LAAM takes the best elements of both laparoscopic and open approaches for myomectomy, using only two small incisions. Fibroids of any size, number, or location can be removed with this approach and the recovery time is less than 2 weeks.
“No large incision! I have to look for it. I was back to work in 2 weeks. I had 17 fibroids removed. Three of them were really big. I felt excavated, all of the junk removed. It feels so liberating to have them all out.” said Azundai after her surgery.
BOOK AN APPOINTMENT WITH FIBROID SPECIALISTS OF CIGC