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Questions To Ask Your Doctor: Fibroid Removal Surgery

Fibroids can be problematic and removing them takes a skilled hand. When speaking to any doctor about fibroid removal surgery, it’s important to feel confident that you are in the best possible hands, and know what questions to ask.

fibroid removal surgeryA diagnosis of fibroids often comes with the advice that patients can watch them and wait to do anything about them. If they don’t affect your daily life, then they can be ignored. But this out-of-date recommendation ignores that when fibroids grow, and they will, they can cause many problems.

The symptoms of fibroids can vary in severity and include:

  • Heavy bleeding and clots with the menstrual cycle resulting in anemia (low blood count) and tiredness
  • Severe pelvic pain with the menstrual cycle
  • Frequent urination
  • Pain in the legs and back, pelvic pressure, swelling of the abdomen, pain with intercourse
  • Constipation
  • Clots in the legs and pelvis

Kidney Damage and the Lesser Known Risks of Fibroids

“Fibroids can disrupt the delicate balance of the important structures in the pelvis,” said Dr. Natalya Danilyants, MD. “These are the structures that help the body to function, creating an important transport system. The ureter leads from the kidney to the bladder to remove urine from the body. The intestines help to remove food waste out of the body. The veins keep blood circulating. It is important for women who have large fibroids to talk to a specialist about the safest way to remove them based on future plans for fertility.”

These problems are more likely with large fibroids, but can be caused by smaller fibroids depending on their location. Women diagnosed with these problems need to have the fibroids removed.

The more common symptoms of uterine fibroids include heavy and/or prolonged bleeding (more than 8 days), pelvic pain, abdominal bloating, and infertility. These symptoms are more easily recognized, and are typically the reason women initially seek treatment.

Minimally invasive GYN specialists perform more advanced techniques that help patients recover faster with less pain.


The Center for Innovative GYN Care board certified minimally invasive GYN surgeons developed the LAAM-BUAO procedure. LAAM stands for Laparoscopic Assisted Abdominal Myomectomy. BUAO stands for Bilateral Uterine Artery Occlusion, which is the permanent or temporary blockage of the uterine artery during the procedure to control bleeding.

LAAM takes the best elements of both laparoscopic and open approaches for myomectomy. Using two small incisions, one at the belly button and one at the bikini line, the CIGC specialists can remove all fibroids regardless of the size, number, or location. LAAM is the most thorough minimally invasive technique used for a myomectomy because the surgeon is able to feel all of the fibroids. LAAM procedures are done in an outpatient setting, and patients are able to return to their lives sooner than with open procedures.


How do you remove fibroids?

There are two main surgical treatment options for removing fibroids: a myomectomy, which only removes the fibroids, and a hysterectomy, which removes the uterus and fibroids. Within these two surgical options, OB/GYNs perform a wide range of surgical techniques with significantly different incision lengths, recovery times, and risk of complications.

This is where the partnership between you and your doctor should come into play. The type of surgery performed should be based on your individual health concerns and desire to have children in the future.

Be sure your physician is using the latest advances in minimally invasive GYN surgery, as explained in our myomectomy and hysterectomy pages.

Are you trained in minimally invasive procedures?

While most OB/GYNs are highly trusted doctors, their focus is obstetrics and basic GYN care, and rarely perform specialized GYN surgeries. Be sure to choose a surgeon who has received comprehensive training and performs many minimally invasive surgeries to remove fibroids each year.

Do you perform robotic myomectomy procedures?

Although the American Medical Association and other leading medical societies have issued statements discouraging robotic techniques due to much higher costs to patients without any medical advantages, robots continue to be used in GYN surgeries, and hospitals continue to invest large sums of money for these tools. This is because the robot enables an OB/GYN not well trained in laparoscopic GYN surgical techniques to perform a procedure through a minimally invasive approach. But these procedures are limited in what they can treat.

This is why women should ask if robotics will be used and seek a specially trained surgeon able to perform the latest minimally invasive surgical techniques without using robotics.

Why is power morcellation still used if it is dangerous?

This is an important question when considering fibroid removal surgery. The reason power morcellators are still used is because they enable many doctors to perform robotic or other minimally invasive GYN procedures. It grinds up the tissue so the surgeon can then remove it through smaller incisions.

The problem is there is a deadly uterine cancer called sarcoma that if undetected, can be spread through the abdomen and pelvis during surgery when the small motorized blades in these devices spin at high speed. The Food and Drug Administration (FDA) now requires all surgeons to tell women in advance if the surgery involves a power morcellator and to get written consent before the surgery takes place.

CIGC NEVER uses power morcellators. Our fellowship trained minimally invasive GYN specialists can perform laparoscopic fibroid removal surgery without using a power morcellator.

Do you partner with any GYN specialists for complicated cases?

It is common practice for doctors to partner with specialists for complex conditions. At CIGC, we partner with many physicians to make sure women have the best options for minimally invasive GYN surgery. Our specialty is GYN surgery. We perform thousands of minimally invasive GYN procedures collaborating with your primary doctor to make sure you have the best overall care.


If your physician recommends an open or robotic procedure, ask why he or she would not recommend a conventional laparoscopic myomectomy or a newer technique like the LAAM-BUAO and always consult another doctor. Do as much research as necessary to find a fibroid removal specialist who will help you understand all of your options and who can perform the most advanced techniques.

It is important to know the risks so you can make an informed choice.


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 Paul MacKoul MD or Natalya Danilyants MD.


Vitals, RateMDs, Google Plus, Wellness, and UCompareHealthCare.


Vitals, RateMDs, Google Plus, Wellness, and UCompareHealthCare.


paul j. mackoul

Even 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.