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.

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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.

At CIGC, we perform minimally invasive resection of pelvic adhesions using the DualPortGYN technique. This approach uses only two 5 MM incisions and recovery time is 1 week. All procedures are performed in outpatient settings, and robotics are never used.

Read Dorran’s story, who was diagnosed with pelvic adhesions from endometriosis, after menopause.

BOOK A CONSULT

To schedule an appointment and get an evaluation with a CIGC specialist, call 888-SURGERY or contact us online. The DualPortGYN technique was developed by Dr. Paul MacKoul and Dr. Natalya Danilyants and has been successfully applied to thousands of GYN procedures.

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.

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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

  • 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.
  • Endometriosis pain can start as early as teen years (see Teen Health: What Severe Period Pain Could Really Mean) or as late as after menopause due to pelvic adhesions from endometriosis (see Dorran’s story).
  • 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.


GETTING DIAGNOSED

  • Symptoms are often dismissed as common or misdiagnosed by untrained professionals. It takes an average of 10 years for a woman to get diagnosed with endometriosis.
  • 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.


ENDOMETRIOSIS TREATMENT

  • 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.

More on endometriosis treatment on InnovativeGYN.com

BOOK A CONSULT

At CIGC, minimally invasive endometriosis excision and laparoscopic hysterectomy is performed using the DualPortGYN technique, with two 5 MM incisions and 1 week recovery time. To schedule an appointment with an endometriosis specialist of CIGC Rupen Baxi MDNatalya Danilyants MD or Paul MacKoul MD, call 888-SURGERY or contact us online.

The Center for Innovative GYN Care has offices in Bethesda, MD, Annapolis, MD and Reston, VA. Out-of-town patients can travel to Washington DC for minimally invasive GYN surgery: discover the CIGC travel program.

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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.

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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.

You can get to know us better on InnovativeGYN.com and through online patient reviews: Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

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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.

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Women who’ve had LAAM myomectomy with Dr. Paul J. MacKoul, MD and Dr. Natalya E. Danilyants, MD at CIGC talk about their surgical experience and how they have been feeling since.

“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.

Read more patient feedback on Dr. Paul MacKoul’s Tumblr here: Women Talk About LAAM: A Safer & Better Myomectomy

To discuss your options for fibroid removal with a CIGC specialist, call 888-SURGERY or contact us online. You can learn more about us on InnovativeGYN.com and through online patient reviews: Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

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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.

CIGC patients have agreed to share their stories and talk about their journey to motherhood.  Ljubica got pregnant naturally after LAAM myomectomy; and Janelle got pregnant with IVF after minimally invasive endometriosis excision. Read their inspiring stories and learn more about GYN conditions affecting fertility in in Dr. Paul MacKoul‘s Tumblr blog: CIGC Patients Get Pregnant After Infertility Surgery For Fibroids & Endometriosis

If you would like to get a GYN evaluation with a CIGC specialist, call 888-SURGERY or contact us online. To learn about CIGC and our innovative approach to infertility surgery, visit InnovativeGYN.com and read online patient reviews: Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

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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.
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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.

LAAM MYOMECTOMY WITH PAUL MACKOUL MD AT CIGC

“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

If you would like to schedule an appointment and go over your options for minimally invasive fibroid removal, call 888-SURGERY or contact us online. Women travel from all across the country for innovative GYN procedures like LAAM and DualPortGYN through CIGC’s travel program.

To learn more about us, visit InnovativeGYN.com and read online patient reviews: Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

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Paul MacKoul MD on Facebook | Natalya Danilyants MD on Facebook
Paul MacKoul MD on Twitter | Natalya Danilyants MD on Twitter
Paul MacKoul MD on LinkedIn | Natalya Danilyants MD on LinkedIn

Women are often misdiagnosed for years and go on to struggle with GYN symptoms affecting their everyday life because they are not properly addressed. Symptoms like severe pelvic pain and abnormal GYN bleeding that can be concerning to a woman, are often dismissed by medical professionals as normal. If a GYN condition is present and causing concerning symptoms, it should be diagnosed and treated early, before more damage occurs.

Dismissed GYN symptoms

Certain symptoms are normal within a specific range, but when you feel like they are causing too much discomfort and pain, it’s time to see a GYN specialist. If you feel your concerns are real, but have been dismissed, be proactive about your GYN health and get a second opinion. Look out for signs of abnormal bleeding and pelvic pain that could indicate a condition.

The right minimally invasive treatment can get women their energy back, prevents future damage and many times clears blocked paths to motherhood. Learn more about what is normal and what is not when it comes to GYN health in this recent blog Dismissed GYN Symptoms: What Are They Really Saying About Your GYN Health?

At CIGC fellowship trained GYN surgeons Natalya Danilyants MD and Paul MacKoul MD perform innovative GYN procedures using only 2 small incisions. Patients recover faster due to the minimally invasive approach and are back to themselves in days rather than weeks. To schedule an appointment with a CIGC physician, call 888-SURGERY or contact us online.  You can get to know us better on InnovativeGYN.com and through online patient reviews: Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

CIGC patient Michelle had been struggling with rectal bleeding with her cycle before coming to see us. Her symptoms were getting progressively worse for nearly 3 years. She saw  a general practitioner, a gastroenterologist and an OB/GYN and none of them was able to recognize the signs of ‪endometriosis. They dismissed her symptoms and could not provide treatment. Michelle was in great pain, feeling hopeless and desperate.

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At a very low point, she heard HOT 99.5 DJ Danni Starr talk about CIGC and decided to call right then. She scheduled her consult with The Center for Innovative GYN Care endometriosis specialist Dr. Paul MacKoul who performed minimally invasive endometriosis excision using DualPortGYN. Read Michelle’s full story on Paul MacKoul’s Weebly.

To get evaluated by a minimally invasive GYN specialist at CIGC, call 888-SURGERY and schedule an appointment or contact us online. Women travel from all over the country for CIGC’s advanced GYN procedures. Get to know us better on InnovativeGYN.com and through online patient reviews: Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

It is estimated that as many as 500,000 hysterectomies will be performed in 2016. Sadly many of them will be executed with unnecessary invasive, higher risk surgical approach: invasive open hysterectomy, blind vaginal hysterectomy, or robotic hysterectomy. It is important that women look into all treatment options and know the risks associated with each procedure.

Hysterectomy-PaulMacKoul

Open GYN surgery means a large incision and up to 8 weeks recovery time. Open procedures have higher risk of infection and have a higher chance of pelvic adhesions forming due to scarring. There are safer, less invasive procedures for almost all patients and any size uterus, resulting in much faster recovery and less post-operative pain.

Vaginal GYN surgery is a blind procedure. Since there is no line of sight within the pelvis, this approach can cause injuries to surrounding structures. It is also very limited in what can be treated (moderate to large uteri can be difficult to remove). The blind approach also accounts for the inability to see and treat other pelvic problems or to assess for bleeding or complications after surgery.

Robotic GYN surgery is performed with a surgeon sitting at a control panel, away from the patient. The robotic  approach has an increased size and number of incisions vs other laparoscopic procedures and accounts for increased complication rates, more pain and longer recovery. The cost of robotic GYN surgery is significantly higher cost, as compared to conventional laparoscopy.

A recent article published in the Journal of Gynecologic Surgery on November 2015 reports that over a 10-year period, a total of 455 injuries and 177 malfunctions from robotic GYN surgery have been reported. The most common gynecologic procedure, hysterectomy, has lead to both injuries and death.

The Risks & Complications of Robotic GYN Surgery: 10 Year Overview

A BETTER MINIMALLY INVASIVE HYSTERECTOMY: DUALPORTGYN

DualPortGYN hysterectomy is an advanced laparoscopic GYN surgery with only two 5 mm incisions, developed by CIGC’s Dr. Paul J MacKoul and Dr. Natalya E Danilyants. This surgical approach helps control blood loss and map the pelvic cavity and it has been successfully applied to thousands of GYN procedures.

Minimally invasive hysterectomy with DualPortGYN is a safe procedure that allows for very fast recovery and minimal pain. Patients return home the same day and are usually back to work at 7 to 10 days. Learn more about DualPortGYN: A Groundbreaking Approach to GYN Surgery

SCHEDULE AN APPOINTMENT

When you are ready to discuss minimally invasive GYN surgery with a trained laparoscopic surgeon, call 888-SURGERY or contact us online. Don’t hesitate to ask for a second opinion if you were recommended open or robotic surgery. There are better, less invasive options to consider.

Visit InnovativeGYN.com to learn about CIGC surgeons Paul MacKoul and Natalya Danilyants and our highly innovative GYN procedures. For real feedback from our former patients, visit online review sites:   Dr. Paul MacKoul ReviewsDr. Natalya Danilyants Reviews.

You know how important your GYN health is. When struggling with GYN conditions and looking for the best treatment, it’s important to find the right specialist that you can fully trust. Women have access to so many great resources now, starting with recommendations from family and friends, to online sources like doctor review sites, to social media and insurance websites.

Once you have scheduled your first consult, don’t hesitate to ask questions and fully express your concerns. If you are not happy with the information you were provided or the approach that was explained to you, don’t be afraid to walk away and get a second opinion. It is important that you are comfortable with your doctor and trust him or her completely.

Find out more in this recent Tumblr blog: How To Research Your Doctor: Dr. Natalya Danilyants & Dr. Paul MacKoul Patient Reviews

CIGC Patients Lisa Sherri Rashetta Fbk

If you are suffering from symptoms like abnormal bleeding and pelvic pain, consider getting an evaluation with CIGC’s surgical specialists: Dr. Paul J. MacKoul and Dr. Natalya E. Danilyants. Advances in GYN surgery now allow for safe & efficient procedures to be performed in outpatient settings with minimally invasive approach, and excellent surgical outcomes.

Call 888-SURGERY or contact us online when you would like to schedule your consult.