Dr. Natalya Danilyants, MD talks about LAAM with the Fibroids Project founder Renee Brown Small
On November 3rd, Dr. Natalya Danilyants, MD, co-founder of The Center for Innovative GYN Care, spoke with Renee Brown Small of The Fibroids Project in an open forum
phone call for women who have been suffering with fibroids. Callers were invited to ask questions about fibroids (size, recurrence, fertility were primary topics), surgical procedures (myomectomy versus hysterectomy) and LAAM (laparoscopic assisted abdominal myomectomy), a minimally invasive fibroid removal technique that leaves practically no scarring, and can treat women with large or multiple fibroids.
CIGC works hard to debunk a lot of myths around GYN surgery and conditions, providing women with tools to be their own best advocates. One of the myths we hear most frequently is that with a large fibroid, a patient isn’t a candidate for minimally invasive fibroid removal surgery. The other myth that many doctors tell their patients is that if you have a large fibroid, but it isn’t bothering you, then just wait it out.
Dr. Danilyants explains why these myths can cause more harm than good for women with fibroids.
Dr. Danilyants begins by describing the LAAM procedure, a safe minimally invasive procedure performed in an outpatient setting:
INTRO: “It allows patients to return home the same day, and recovery is about 2 weeks, and it eliminates the limitations and risks of standard laparoscopic and open procedures: blood loss is controlled with the use of a tourniquet, decrease the risk of blood transfusions, eliminates the risk of a surgeon converting to an emergency hysterectomy.”
Q. How is it that you are able to perform the LAAM procedure on any size fibroid?
“The biggest fear with myomectomy is excessive bleeding. By using the tourniquet which is placed laparoscopically, we are able to control the blood supply to the uterus during surgery, we are able to remove the fibroids large or small with minimal bleeding. We stitch the uterus by hand through a small incision, about 2 inches, or even smaller, to reconstruct the uterus after taking all of the fibroids out through that incision.
“It is a technique that other doctors are not familiar with. Because they are not able to control the bleeding, other doctors are not able to offer it.”
Q. How long have you been doing this procedure?
“We’ve been doing this procedure for about 5 to 10 years. We have perfected it over the years. About 10 years ago we were using 3 1/4 inch incisions and the lower incision was 2 inches. And now we are down to 2 incisions, one in the belly button about a 1/4 of an inch, and one in the bikini line about 1.5 to 2 inches. We have figured out how to do it with less incisions, but still maintain the safety of the procedure.”
Q. I am 36 and I was diagnosed with fibroids at 28 years old. I have 2 hanging off of my uterus and one big one that’s behind my uterus. Would I be a candidate for the LAAM procedure because of the location or the size?
“Yes, you would be a candidate for this procedure. That’s the beauty of this procedure, that no matter if the fibroids are in the back of the uterus, in the front, the side, whether they are inside the uterine cavity, the LAAM procedure can address any of those fibroids.”
“An important thing to remember is that you’ve had the fibroids since you were 28, and you are 36. The fibroids will continue to grow. That’s a very important point. A lot of patients that come see me with very big fibroids, they have known about these fibroids for many years, but they were told ‘Just leave them; if they don’t bother you, don’t bother them,’ but that’s really not the right approach. The fibroids will continue to grow. Eventually, you are going to have symptoms. You really don’t want to wait to get to the point where your fibroids are so large that they have already caused damage to the uterus, especially if you are planning to have more children. Removing those fibroids, there may have already been irreversible damage.
“The message here is anyone with fibroids should see a specialist and determine if the fibroids are at a size where they should be addressed right away. If they are really small, then you may not need surgery. But if they are large, it is better to have them out, and get a once a year ultrasound to make sure that no new ones are coming back.”
Q. I’ve had fibroids for 10 years, and have wanted to have procedures. For a long time my doctor and I weren’t communicating properly. I wasn’t ready to have a partial hysterectomy. Do you think there is validity to that?
I think every individual is different, if you are done having children and you have fibroids, partial hysterectomy is an option, and it’s not a bad option. The reason is, the fibroids can never come back. And that’s a big thing, because no matter how you remove the fibroids, whether you do it through a quarter inch incision or a 15 inch incision, the fibroids can come back. Lets say you are 40 years old and you have fibroids removed. You still have at least 10 years until menopause. That’s 10 years during which the fibroids can come back, and you may end up having to have another surgery. Any surgery, no matter whether you have the best expert in the world doing it, or have your doctor next door, it can have potential complications. It’s a really big decision to have surgery at all.
So if you are done having children and you have fibroids, it may be better to have a partial hysterectomy rather than the LAAM procedure. And a partial hysterectomy doesn’t have to be an open surgery, even if you have really big fibroids. You can have a minimally invasive procedure. The one that we do for example is called DualPortGYN, and it uses only 2 quarter-inch incisions. We can detach a very big uterus that way. That’s a great procedure for women who are done having children and have fibroids, but don’t want to have to deal with fibroids ever again.”
Q. Is there an increase likelihood of damage to the ovary? I only have one ovary, so I’m very invested in making sure that it remains okay and not hastening menopause.
“Technically no. If you have an expert doing your surgery that decreases your risk of complications, period, and there is less risk of damage to the ovary, and having to remove an ovary. When we talk about removing or not removing the ovary prior to surgery, there are no surprises. There is no reason to remove it if it’s normal, and depending on how old you are, it should have normal function.”
Q. How do you classify a doctor as an expert? How do we go about finding those you would consider an expert?
If you go online, you can find so many experts, but then, the truth is, how many of them are real experts? The most objective way is to ask how may surgeries have they done, and how many surgeries do they do per week, or per month. An average OB/GYN, a doctor who performs obstetrics (delivering babies) and gynecology, they do only about 20 major surgeries per year.
A specialist does about 10 to 15 surgeries per week. That’s all my practice is. Part if it is surgical talent, but part of it is practice. A specialist is going to be doing so many surgeries, constantly perfecting their skill. Just ask your doctor, how many surgeries have they performed. Also, do they use a robot. Robotic surgery has no advantage over laparoscopic surgery, and actually has more risks associated with it. Also ask them, ‘What are the chances I’m going to end up with open surgery?” They may say that you are not even a candidate for laparoscopic surgery, and that’s your answer right there, they are not an expert. But if they say that yeah we can do laparoscopic but we may still end up opening you, that should be your red flag right there. You should go to someone who can guarantee laparoscopic surgery.
To listen to the full recording, visit our YouTube channel.
Our surgeons developed the groundbreaking LAAM, a thorough minimally invasive uterine-sparing fibroid removal technique, and DualPortGYN for minimally invasive hysterectomy. Both procedures use only 2 small incisions, one at the belly button, and the other at the bikini line.
If you have large or multiple fibroids, and have been told you need to have an open or robotic myomectomy, or that a hysterectomy is your only option it’s important to get a second opinion to fully understand your condition and your surgical options. It is also important for the surgeon to understand what your goals are for fertility, so that he or she can make the best recommendation for your personal needs.
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 Danilyants and Dr. Paul MacKoul. 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 Dr. Paul MacKoul, MD or Dr. Natalya Danilyants, MD.
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