Incision Placement In Laparoscopic GYN Surgery Reduces Pain

October 4, 2016

Incision placement in laparoscopic GYN surgery reduces pain

Minimally Invasive GYN Procedures Performed Through Tiny Midline Incisions Provide Optimal Patient Recovery

In minimally invasive GYN surgery, incision placement and size plays a significant role in patient recovery time. When incisions and instruments have to pass deep within the muscle they take a long time to heal. However, strategic incision placement through the midline of the abdomen bypasses muscle, allowing for a faster recovery with minimal pain.

The Center for Innovative GYN Care co-founders developed the DualPortGYN technique and LAAM technique to take advantage of these types of incisions, as well as leverage advanced minimally invasive techniques for controlling blood loss and mapping of the pelvic cavity for clear visualization. Combined, small incisions, retroperitoneal dissection and uterine artery occlusion (or ligation) make treating complex conditions like an enlarged uterus, fibroids, ovarian cysts, pelvic adhesions, and endometriosis possible.

“Any fibroid left behind after a myomectomy has the chance to grow larger, and leave the patient returning for a future myomectomy or hysterectomy,” said Dr. Natalya Danilyants, MD. “The beauty of the LAAM technique is that we can use very small incisions to remove fibroids because we can feel them. Robotic surgery or conventional laparoscopic techniques cannot offer that.”


One of the primary advantages of modern minimally invasive procedures is that the reduction in incision size is balanced with high-definition laparoscopes that provide surgeons a clear view within the body. At CIGC, the advanced-trained specialists combine technology, skill and experience to provide women with a superior procedure.

“The laparoscope is placed through the belly button and the surgical tool is placed above the pubic bone, eliminating the risk of muscle and blood vessel injury, superficial nerve injury during surgery, or nerve entrapment during closure that could cause numbness or chronic pain,” said Dr. Rupen Baxi, MD. “It is revolutionary to have a technique for all GYN conditions that can avoid superficial nerve damage. Patients have minimal requirement for pain management after surgery, leading to a positive experience from surgery to recovery to getting back to living their lives.”

Conventional laparoscopic and robotic laparoscopic procedures use incision placement that has a higher likelihood of lacerating blood vessels and damaging nerves, but at minimum, they go through musculature that takes much longer to heal, and has a higher level of pain during the recovery.

A Comparison of Minimally Invasive Hysterectomy Procedures



Laparoscopic hysterectomy procedures performed with the DualPortGYN technique use just 2 tiny 5 mm incisions that avoid the abdominal muscles. This incision placement makes it possible for women to recover from procedures like hysterectomy in a week or less. All procedures are performed in an outpatient setting, and patients return home the same day.

By comparison, other laparoscopic hysterectomy techniques take much longer to recover, have higher complication rates, take longer in the operating room, and often require a minimum of an overnight stay at a hospital.

The incisions with the DualPortGYN technique are so small that they are practically invisible a couple of months after surgery.

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Conventional laparoscopy for GYN procedures requires three to four 5 mm ports. While the number of ports may not appear to be high, the placement of 1-2 of the ports are directly through the muscle, which increases the recovery time, and pain. They also risk damaging the nerves that can cause pain immediately after surgery, but discomfort may occur for months to years after the surgery.

Convention Robotic

Robotic surgery requires 5 ports. Two of the ports are 12 mm, and three are 8 mm. Four of these ports, including the larger ports, go through the abdominal muscles. Robotic procedures take longer to perform and have at least twice to four times the recovery time of a DualPortGYN procedure.

The LAAM Myomectomy

Even with small incisions in the midline, LAAM has no limit to the size or number of fibroids that can be removed safely. This is due to the ability to control blood loss, excellent visualization of the pelvic cavity and access to the uterus for the surgeon to feel for the fibroids. Standard and robotic laparoscopic approaches to myomectomy do not allow the surgeon to feel fibroids in the uterus, and they can often miss those deep in the muscle which can cause problems with infertility and cause persistent bleeding. In addition, if smaller fibroids are missed with these approaches, that can allow continued fibroid growth and increase the need for additional surgery. The recovery with LAAM procedures is similar if not better than standard laparoscopy, with far fewer complications or need for blood transfusion. There is no overnight hospital stay.

LAAM is one of the safest fibroid removal surgeries available, affording patients a far more effective outcome, with a faster recovery.

The skill and experience of the CIGC specialists allowed significant attention to detail while developing the DualPortGYN and LAAM techniques to ensure a better surgical outcome and reduced recovery time with much less pain.


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 J. 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.

Offices are conveniently located throughout the Washington D.C. area in Rockville, Maryland, and Reston, Virginia. Women looking for a GYN specialist for a laparoscopic hysterectomy, endometriosis excision or fibroid removal travel to CIGC from around the world.


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CIGC-Travel-Map-FBEven 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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10 Mayo Clinic

11 Paraiso MF, Ridgeway B, Park AJ, et al. A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. AJOG. 2013;208(5):368.e361–367.

12 Yeung P, Bolden C et al. Patient Preferences of Cosmesis for Abdominal Incisions in Gynecologic Surgery. JMIG. 2013; 20(1): 79-84

13 Jones, H. W., III, & Rock, J. A. (2015). Te Linde’s operative gynecology (Eleventh edition). Philadelphia: Wolters Kluwer.

14 Royal College of Obstetricians & Gynaecologists, London, UK.

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