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.  

ON THIS PAGE:

• The DualPortGYN® Difference
• Superior Results
• Avoiding COVID-19
• When DualPortGYN Hysterectomy Is Not the Answer

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.

The DualPortGYN® Difference

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.

Superior Results

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.

Avoiding COVID-19

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:

• ASCs do not treat COVID-19 patients.
• Their same-day discharge model quickly gets patients back to the safety of their home.
• Their smaller footprints are easier to keep clean and sterile.

When Hysterectomy is Not the Answer

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.

About the Author

Paul J. MacKoul, M.D. Dr. Paul J. MacKoul, co-founder of The Center for Innovative GYN Care, is fellowship-trained in GYN oncology and specializes exclusively in minimally invasive GYN surgery. He co-developed the advanced laparoscopic techniques DualPortGYN® and LAAM® with Natalya Danilyants, M.D.; both procedures have unmatched outcomes compared to other methods of minimally invasive GYN surgery. 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. View Bio

References:

1. MacKoul P, Danilyants N, Baxi R, van der Does L, Haworth L. Laparoscopic hysterectomy outcomes: Hospital vs Ambulatory Surgery Center. JSLS. 2019;23(1):e2018.00076. doi:10.4293/JSLS.2018.00076
2. MacKoul P, Baxi R, Danilyants N, van der Does LQ, Haworth LR, Kazi N. Laparoscopic-assisted myomectomy with bilateral uterine artery occlusion/ligation. J Minim Invasive Gynecol. 2019;26(5):856-864.  Doi:10.1016/j.jmig.2018.08.016.
3. Mehta A, Xu T, Hutfless S, Makary M, Sinno A, Tanner E, Stone R, Wang K, Fader A. Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications. Am J Obstet Gynecol. 2017;216(5):497.e1-497.e10.  Doi:10.1016/j.ajog.2016.12.020