In a recent interview with Thrive Global and Authority Magazine writer Christine D. Warner, Dr. Paul MacKoul explores the circumstances surrounding the lack of expertise when it comes to minimally invasive GYN surgery, which in many cases leads to sub-par outcomes for women being treated for complex GYN conditions: the proliferation of robotics and their acceptance as the standard of laparoscopic GYN care, the bond of trust between a patient and their OBGYN, and the fact that most OBGYNs have not received the advanced surgical training necessary to treat GYN conditions.
But women do have hope. Backed by published peer-reviewed research, the minimally invasive techniques developed by Paul MacKoul MD and Natalya Danilyants MD, co-founders at The Center for Innovative GYN Care® (CIGC®), render superior outcomes with faster recovery time and less pain – all in an outpatient setting, which means lower costs for patients as well.
Learn more about what inspired Dr. Paul MacKoul to specialize in laparoscopic GYN surgery and his “big idea that might change the world.”
Can you tell us a story about what brought you to this specific career path?
In the U.S., the OBGYN generalist is the patient’s “go to” source for GYN surgery. It is understandable that a patient in the OBGYN’s practice, who has had deliveries for babies and office GYN care over many years, would believe that their OBGYN is also a skilled laparoscopic surgeon. That patient has built a “bond of trust” with their OB, and when surgery is needed, that trust translates into the same OB performing surgery. But is that OB really a surgical expert, and one that can provide the best possible care?
The field of Obstetrics & Gynecology is one of the most varied and disassociated in all of medicine. OBGYNs do obstetrics, office gynecology, surgery, as well as some fertility, oncology, and other subspecialties of the field. Regardless, the vast majority of the OBGYN’s work is in Obstetrics. OBGYNs are consumed with Obstetrics — their practice is centered around Labor and Delivery at the hospital, and the majority of their income is from Obstetrics work. So how does the OBGYN manage to train and develop as an expert in Gynecologic surgery? Simply stated, the OBGYN does not have the time, focus, patient volume, and training or financial incentive to become that expert. When you think about surgical specialties such as Orthopedics and others, the focus is 100% on surgery 100% of the time. This is not clinically or economically possible for the OBGYN. Despite this, 95% of patients requiring surgery have it performed by the OBGYN generalist, and for the above reasons the patients believe that their OBGYN is that surgical expert.
During my residency training, this problem became clear. Many OBGYNs, responsible for training me during my four years in a large University program, were having difficulty. A bladder was inadvertently injured — call the Urologist. The bowel was “stuck” to the uterus — call the General Surgeon. The patient had large fibroids and was bleeding during a myomectomy, or there was extensive Endometriosis making every pelvic organ including the uterus, tubes and ovaries adherent to each other — call the GYN Oncologist. GYN Oncologists had advanced training in GYN surgery for cancer and complex GYN conditions, and were the “surgical experts” of the field. The GYN Oncologist participation even extended into Obstetrics. Heavy bleeding during a complication with delivery also required a call to the GYN Oncologist. It was obvious that the GYN Oncologist was indeed the OBGYN’s surgeon, and was often “on call” for difficult cases that the OBGYN could not handle. As I began to see GYN Oncologists at work, I realized I had no choice but to try and become one of them. I focused the remainder of my residency on surgery as much as I could, and moved on toward a fellowship program in GYN Oncology. As a GYN Oncologist, Obstetrics is not part of the training program. The focus is entirely on surgery. For four years in OBGYN residency, I spent at least 75% of my time learning the field of Obstetrics, all of which was now discarded for a three year training program on the management of cancer patients and complex surgery. Now, as a GYN Oncologist, I am able to focus on GYN surgery 100% of the time, and have developed new techniques and procedures to advance the field of Minimally Invasive GYN Surgery to decrease complications and enhance recovery for patients.
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