Top Questions: Fibroids And Minimally Invasive GYN Surgery

August 4, 2015

Question marks with one that is golden
fibroids and minimally invasive surgery

Being told that open or robotic procedures are the only answer for GYN conditions can leave a lot of women looking for better answers. Learn more about CIGC procedures for fibroids.

Often, when a patient is seeing a doctor for the first time about fibroids, there can be hesitation to ask questions. Or in the midst of trying to get as much out of the time you have, you may forget something. When you are able to listen to questions from others and hear the answers from the experts, it can prompt additional thoughts and scenarios that you may not have initially considered.

Knowing this, The Center for Innovative GYN Care surgical specialists wanted to give women considering surgery for fibroids an opportunity to listen to an in-depth presentation on fibroid removal while leaving the uterus intact for fertility. Highlighting the benefits of LAAM and DualPortGYN, Dr. Natalya Danilyants, MD and Dr. Paul MacKoul, MD were able to answer questions in a forum, where women could freely ask questions and remain anonymous.

Hearing a surgeon address concerns and fears from others about fibroids and minimally invasive GYN surgery can be a huge benefit for patients who are on the fence about having a procedure, and for other women doing online research, the answers to some of those questions are below.

Top questions on Fibroids and Minimally Invasive Surgery from women around the DC area:


One of the most important questions that was asked was “If LAAM is the best way to remove fibroids and has such positive benefits then why aren’t more doctors doing it?”

LAAM and DualPortGYN are surgical techniques that were developed by the GYN surgical specialists at CIGC. The techniques used for LAAM (and DualPortGYN) are advanced. The surgeons at CIGC are fellowship trained, which means they had intensive training beyond medical school to perfect minimally invasive surgical techniques. Two of these techniques, retroperitoneal dissection (RPD) and uterine artery ligation or occlusion (UAL/UAO) make LAAM and DualPortGYN possible. RPD and UAL/UAO require a skilled and experienced surgeon in order to perform them with a high success rate.

The placement of a tourniquet to prevent bleeding is a very difficult technique to perform, and that’s why it is such a unique procedure. As CIGC training programs for LAAM and DualPortGYN expand, more surgeons across the country will begin to perform GYN procedures using them.


Are candidates who previously had open myomectomies candidates for LAAM? If so, can the incision be made using the existing scar?

Yes, the incision at the bikini line can be used for the LAAM procedure, though the surgeons would only use a small 1.5 inch incision in the center of the incision.

The problem with fibroids is that they almost always come back. Once a woman has fibroids, after a myomectomy, the likelihood of recurrence is high. The CIGC surgeons have performed many surgeries on women who have had previous open myomectomies or caesarean section births, and going in through the original scar is not a problem.

It’s actually better to go through the same scar, since the area is already numb from the previous surgery, and patients generally have even less pain.


What is the number of surgeries you have performed?

The CIGC surgeons have performed over 20,000 gyn surgeries, including thousands of myomectomies.


What is the percentage of LAAM procedures converted to hysterectomies?

Of the thousands of myomectomies that have been performed by the CIGC surgeons, there has been only one that was converted to a hysterectomy. That’s less than 1 percent. While minimally invasive hysterectomies are performed extensively by the CIGC specialists, if a woman wants to maintain fertility, they will always take the wishes of the patient into account.

How can an extremely large fibroid or groups of fibroids be removed from such a small incision?

Once the initial work is completed, the retroperitoneal dissection and the uterine artery ligation make it very easy for the surgeon to see and remove fibroids. Large fibroids are pulled towards the incision and if necessary, they are segmented into smaller pieces to be removed. Each fibroid is removed 1 at a time. The uterus is reconstructed after the surgery so that as a patient begins to pursue natural conception or IVF, the uterus is able to carry a child to term.

How many LAAM procedures are normally performed each week?

Between 10-12.

How can you guarantee that some part of the fibroid isn’t left behind?

With the LAAM procedure, you can see and feel the fibroids in the uterus. When the fibroid is removed, it is guided to the incision entrance where it is either removed intact or sliced manually into segments. This allows the surgeon to have complete control over the fibroid.


How do you feel the fibroids?

The small incision at the belly button allows the surgeon to insert a finger into the uterus. The ability to feel each fibroid means that removal can be done thoroughly.



If you have additional questions that you would like to ask our surgeons, you can submit them through our Ask a Doctor feature on our website.


Surgical specialists can often see patients sooner because they are focused entirely on surgery. Each patient gets detailed, in depth attention from Dr. Danilyants and Dr. 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.


Paul MacKoul Reviews

Natalya Danilyants Reviews


CIGC travel program

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.

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