Paul J. MacKoul, M.D., co-founder, The Center for Innovative GYN Care
Women with heavy bleeding and pelvic pain due to fibroids who do NOT desire fertility can achieve permanent relief from their symptoms with hysterectomy surgery. Determining which surgical procedure is right for them depends on several crucial factors.
Fibroids — noncancerous tumors that grow in the uterus and may become large enough to affect nearby organs — have many options for treatment. Minimally invasive hysterectomy, when performed using dual-port procedures, can provide one of the best short- and long-term options for care. When preserving fertility is not an issue and hysterectomy is being considered, a partial hysterectomy (preservation of the ovaries and/or cervix) or less often a complete hysterectomy (removal of the ovaries and/or cervix) can be performed.
One of the chief decisions a patient will need to discuss with her physician is what kind of surgical technique will be used — in other words, how the surgeon will access the uterus. This choice will affect everything from the risk of complications to the level of pain the patient may experience and how long recovery may take.
Specialists at The Center for Innovative GYN Care developed a technique called DualPortGYN, the safest and most advanced laparoscopic technique in the world for eliminating fibroids —even very large ones — via minimally invasive hysterectomy. DualPortGYN, which can also be used to treat other GYN conditions such as ovarian cysts and adenomyosis, is only performed by a small number of surgeons in the United States and internationally due to the high level of training required to master it.
Two different techniques make up the DualPortGYN method.
The first involves approaching the reproductive organs not through the abdominal muscles, but via the retroperitoneum, using just two small incisions. This non-traditional retroperitoneal approach is rarely performed by most OBGYN surgeons, and allows for better navigation of the pelvic anatomy, including the ureter, bladder, and uterine artery. This safety-enhancing approach reduces the risk of injuring these structures, minimizes blood loss, and results in less pain and a quicker recovery.
The second technique, uterine artery ligation, also minimizes blood loss. The combination of these techniques increases the safety and effectiveness of the surgery.
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Before deciding what kind of procedure to have, compare the outcomes for DualPortGYN to the others.
As the chart below shows, patients whose hysterectomies were done via DualPortGYN enjoy superior outcomes compared to three other permanent fibroid-removal techniques, according to published studies.¹ These techniques include the standard laparoscopic method, the robotic-assisted laparoscopic method, and the traditional open abdominal method, which is the preferred approach of many OBGYNs in the United States.
| Our DualPortGYN Procedure |
Standard Laparoscopic |
Robotic | Open | |
| LENGTH OF PROCEDURE | 30 min–1 Hour | 2–3 Hours | 2–3 Hours | 1–2 Hours |
| NUMBER OF INCISIONS | 2 (5 mm) | 4 (5 mm) | 3–7 (8–12 mm) | 1 Large (10–15 cm) |
| HOSPITAL STAY | 0 Days | 0–1 Day | 1–2 Days | 3 Days |
| RECOVERY TIME | About 1 Week | Up to 3 Weeks | Up to 6 Weeks | Up to 8 Weeks |
| CONVERSION TO OPEN PROCEDURE | 0% | 4.8% | 0.4% | N/A |
| COMPLICATON RATES DURING SURGERY |
2.1% | 6% | 5.6% | 9.6% |
DualPortGYN has an additional safety advantage over other methods: . CIGC specialists perform their DualPortGYN outpatient procedures at a fully accredited ambulatory surgery center (ASC), rather than in a hospital. It is not performed in a hospital, but rather at The Center for Innovative GYN Care’s fully accredited ambulatory surgery centers (ASCs).
ASCs have multiple safety advantages over hospitals. Safety is enhanced because:
Fibroids can interfere with conception and increase the risk of miscarriage. But because hysterectomy removes the uterus, it is clearly not an option that women who desire to bear a child should pursue.
To remove fibroids and preserve fertility, CIGC specialists developed LAAM®, or laparoscopically assisted abdominal myomectomy. This procedure also uses only two incisions and can remove a large number of fibroids, including small, harder-to-detect tumors in the uterine wall and near the cavity, which cause the highest rates of infertility.²
Despite having the least desirable outcomes compared to DualPortGYN, standard laparoscopic and robotic-assisted hysterectomy, open abdominal procedures account for about half of these surgeries in the United States. A two-year analysis of 5,660 procedures in Maryland found that more than 60% were performed using the open abdominal method.³ Patients seeking relief from fibroid symptoms for whom removal of the uterus is not a concern would do well to consider the more favorable surgical and recovery outcomes of DualPortGYN.
CIGC is dedicated to providing information and materials for women to help navigate the complicated health care system. The CIGC founders, minimally invasive GYN surgical specialists Paul MacKoul, MD, and Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind.
Their personalized approach to care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed more than 25,000 complex GYN procedures and are constantly finding better ways to improve outcomes for patients.
Talk to a specialist about having a better hysterectomy experience with the DualPortGYN technique.
 Paul J. MacKoul, M.D. Dr. MacKoul, who is also CEO of the GYN ASC management company Tower Surgical Partners, graduated from medical school at Tufts University, then completed his residency in OBGYN at the University of Maryland. His fellowship in gynecologic oncology was at the University of North Carolina. |
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