Technique RESEARCH

CIGC PROCEDURES

DualPortGYN – Advanced laparoscopic surgery to treat all GYN conditions, including fibroids, endometriosis, ovarian cysts, pelvic organ prolapse,

LAAM Fibroid Removal For Fertility  – A hybrid of laparoscopic and open techniques, taking the best elements of both for women who are able to maintain fertility.

The CIGC Advantage  – Complex GYN conditions require specialist care. The Center for Innovative GYN Care surgeons perform procedures that protect the patient to ensure optimal outcomes. By controlling for blood loss and improving visibility, even the most complex conditions can be treated in an outpatient setting with better long-term results than other techniques.

NON-CIGC PROCEDURES

Embolization UFE – UFE is not recommended to treat large fibroids or for women who want to get pregnant. Fibroids decrease in size, but do not go away, and for large fibroids, the reduction in bulk may not be enough to reduce symptoms. In many cases, women will need to have multiple procedures, including additional UFE treatments, myomectomy or hysterectomy.

Laparoscopic GYN Procedures  – Other laparoscopic techniques for GYN surgery are limited in what conditions can be treated. Without performing techniques that control for blood loss or improve visibility, standard laparoscopic techniques have a higher incidence of complications and lower positive patient outcomes than CIGC techniques.

Robotic Surgery  – Robotic surgery to treat complex GYN conditions has a higher risk of complications both during the operation (increase blood loss, longer time under anesthesia) and after the operation (damage to the ureter or bowel may appear after surgery is completed, and patients may have to have a second procedure to correct potentially life-threatening injuries)

Embolization UFE

UFE is not recommended for women who want to get pregnant.

Pregnancy after uterine artery embolization for fibroids.

Desired future pregnancy remains a relative contra-indication to UAE for symptomatic fibroids. Obstetric risks after UAE for fibroids include prematurity, intrauterine growth restriction, abnormal placentation, and increased likelihood of cesarean delivery.

Sukhbir S. Singh, Can Fam Physician

UFE is not recommended for women with large fibroids.

Uterine leiomyomas (fibroids): Treatment with uterine artery embolization
Authors & publication
Sanne M van der Kooij, MD, PhDWouter JK Hehenkamp, MD, PhD, UpToDate

Location – Subserosal or submucosal fibroids that are pedunculated and have a narrow stalk (stalk <50 percent in diameter in comparison with the largest diameter fibroid) are considered a relative contraindication [for UFE] because these fibroids may detach either intraperitoneally or within the uterine cavity; submucosal fibroids that detach may be expelled vaginally [21]. Detachment may be associated with sterile peritonitis or intrauterine infection.

Size or number of fibroids – The volume of necrosis after UAE in a large fibroid uterus can be substantial with a proportionate level of postprocedural pain and risk of infection. However, no clear threshold for the size of the uterus or size or number of fibroids has been established as a contraindication. The only study to address this question was a case series of women with a dominant fibroid of >10 cm and/or a uterine volume of >700 cm that found no increase in the risk of serious complications [22]
Etc, etc.

Laparoscopic GYN Procedures

Fact: Standard laparoscopic GYN techniques are limited in what conditions can be treated.

Laparoscopic GYN Procedures

The Center for Innovative GYN Care is committed to providing the best patient results for treatment of complex GYN conditions. For that reason, it is important for patients to understand why we only perform and only recommend DualPortGYN and LAAM procedures for hysterectomy, myomectomy (fibroid removal), cystectomy, prolapse repair and other complex GYN procedures.

In order to make the best decision, it’s important to have all of the facts.

Two retrospective studies were performed at a local Maryland hospital to compare surgical techniques for hysterectomy and myomectomy procedures.

HYSTERECTOMY: In the comparison of 2,568 patients who underwent a laparoscopic hysterectomy procedure (the review included patients who had DualPortGYN, Robotic or standard laparoscopic surgery), DualPortGYN (also known as laparoscopic retroperitoneal hysterectomy or LRH) clearly showed the best patient outcomes with the lowest complication rates, and 0% conversion to open surgery.

MYOMECTOMY: In the comparison of 1,313 patients who underwent a myomectomy (the review included patients who had LAAM, robotic, standard laparoscopic or open myomectomy procedure), LAAM (laparoscopic assisted abdominal myomectomy), showed the best patient outcomes, including removal of large

Robotic Surgery

UFE is not recommended for women who want to get pregnant.

Pregnancy after uterine artery embolization for fibroids.

Desired future pregnancy remains a relative contra-indication to UAE for symptomatic fibroids. Obstetric risks after UAE for fibroids include prematurity, intrauterine growth restriction, abnormal placentation, and increased likelihood of cesarean delivery.
Sukhbir S. Singh, Can Fam Physician. 2007 Feb; 53(2): 293–295.

UFE is not recommended for women with large fibroids.
Uterine leiomyomas (fibroids): Treatment with uterine artery embolization
Sanne M van der Kooij, MD, PhDWouter JK Hehenkamp, MD, PhD, UpToDate

Location – Subserosal or submucosal fibroids that are pedunculated and have a narrow stalk (stalk <50 percent in diameter in comparison with the largest diameter fibroid) are considered a relative contraindication [for UFE] because these fibroids may detach either intraperitoneally or within the uterine cavity; submucosal fibroids that detach may be expelled vaginally [21]. Detachment may be associated with sterile peritonitis or intrauterine infection.

Size or number of fibroids – The volume of necrosis after UAE in a large fibroid uterus can be substantial with a proportionate level of postprocedural pain and risk of infection. However, no clear threshold for the size of the uterus or size or number of fibroids has been established as a contraindication. The only study to address this question was a case series of women with a dominant fibroid of >10 cm and/or a uterine volume of >700 cm that found no increase in the risk of serious complications [22]
Etc, etc.

Laparoscopic GYN Procedures (daughter page)

Fact: Standard laparoscopic GYN techniques are limited in what conditions can be treated.