Revolutionary Benefits of Smaller Incisions for Fibroid Removal

January 5, 2017
GYN Surgery

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Rupen Baxi, MD | The LAAM Advantage: Ultra-Minilaparotomy

Dr. Rupen Baxi, MDAs technology improves, highly skilled minimally invasive GYN surgeons can perform complex procedures using increasingly smaller incisions.

Through years of training and experience, the GYN surgical specialists at The Center for Innovative GYN Care have developed advanced laparoscopic techniques for hysterectomy, myomectomy, ovarian cystectomy, endometriosis excision, and removal of pelvic adhesions (scars). The advantage of surgery at CIGC is the use of the smallest incisions possible with remarkable results, including an ultra-minilaparotomy

Dr. Rupen Baxi, MD explains the use of an ultra-minilaparotomy for the removal of fibroids of almost any size.

“Ultra-minilaparotomy is approximately 3-4 cm incision compared to a 5-8 cm incision for mini-laparotomy,” said Dr. Baxi. “It is performed in the same manner and location as a Pfannenstiel incision, also known as the “bikini cut”. It is considered to be cosmetically superior as the incision is made along the “lines of Langerhans”, 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 myomectomy techniques.”

The LAAM ProcedureRemoving large fibroids is often problematic for many surgeons because controlling loss of blood is one of the main safety concerns throughout the entire procedure.  The combined techniques: ultra-minilaparotomy, retroperitoneal dissection, and uterine artery occlusion are what sets the CIGC LAAM technique for fibroid removal apart from other myomectomy procedures.

“The LAAM procedure incorporates advanced hemostasis (control of blood loss) techniques that allow CIGC surgeons to perform myomectomies that most physicians are not even capable of performing via an open procedure, let alone a minimally invasive approach. Combine that with the ultra-minilaparotomy and we now have powerful techniques to accomplish large and complex cases. Key benefits are significantly reduced blood loss which lowers the risk of blood transfusions, same day discharge, lower narcotic pain medication use and faster recovery to normal life.”

The LAAM technique was developed to minimize the risk of complications during other fibroid removal techniques and improve patient outcomes.

“Blood loss, restricted visibility and inability to reach challenging locations of the pathology are major limitations to any procedure. Additionally, closing the uterine defects can be a major challenge with laparoscopy and robotic assisted myomectomy. With the LAAM technique, hemostasis is quite excellent which allows for clear visibility during surgery. The ultra-minilaparotomy adds to improved visualization, but it also allows the palpation of the uterine muscle to locate fibroids deeper and in all locations of the uterus. Another major advantage of the ultra-minilap is that it enables a hand sewn multi-layer closure of the uterine defect which is considered to be stronger than laparoscopic suturing.”

“These are highly advanced techniques and they not only require fellowship training, but also high volume surgical experience,” continue Dr. Baxi. “This also extends to the advanced equipment, high trained staff and anesthesia care, as well as years of research data that was used to perfect these techniques. They are not easily performed by any surgeon nor should they be as the potential for complications can be high if not performed by specially trained surgeons in the techniques.”


“In today’s healthcare, patients often feel confused and under-educated on their condition, often resorting to the internet for guidance. Patients feel that not enough time was spent with them by their physician and the education provided was not comprehensive enough.”

Questions to Ask Your Surgeon

“Often, patients do not know the difference between the different types of surgeons, and they trust their OBGYN to provide the best surgical option. Patients also feel that they did not know the correct questions to ask their surgeon and they were not comfortable asking questions. These are some of the things that prevent them from getting the best care for their condition.”

Non-invasive techniques like UFE are not thorough.

“LAAM allows for the removal of the pathology. UFE or ablation does not. The difference is removing the offending problem versus cutting off the blood supply to problem allowing it to rot and degenerate. With ablation, you are applying heat in hopes of destroying the fibroid, but it is still present in the uterus. Regardless of the approach, LAAM is the only one that removes it altogether and allows for pathology testing for cancer and other abnormality such as Adenomyoma. UFE and ablation does not allow for pathology testing as no specimen is removed.”

Learn more about the benefits of fibroid removal at CIGC.


The CIGC state-of-the-art specialists are available at three locations in the DC metro area. Virginia patients can visit the Reston, VA location, and Saturday appointments are available. Maryland offices are located in Rockville, MD and Annapolis, MD.

GYN surgical specialists can often see women sooner because they are focused entirely on surgery. Each patient gets detailed, in depth attention from Dr. Natalya DanilyantsDr. Paul MacKoul and Dr. Rupen Baxi. This personalized care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed over 20,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.

Book a consultation today with Paul MacKoul MD, Natalya Danilyants MD or Rupen Baxi, MD.

Dr. Paul MacKoul ReviewsVitals | RateMDs | Google | Wellness | UCompare

Dr. Natalya Danilyants Reviews: Vitals | RateMDs | Google | Wellness | UCompare

Dr. Rupen Baxi ReviewsRateMDs | Google | HealthGrades | WebMD


CIGC Travel ProgramEven if you are not from the DC area, many patients travel to The Center for Innovative GYN Care for our groundbreaking procedures. We treat women from around the world who suffer from complex GYN conditions.

Learn more in our travel program.

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