When to seek a GYN specialist: fibroids, endometriosis, and pelvic pain

This content is sponsored by The Center for Innovative GYN Care

Forming a long-lasting bond with an OBGYN is normal. They answer the hard questions about delicate matters, deliver our children, and well-woman exams often replace annual physicals. When a patient finds the right doctor for her, consulting a specialist may feel like a betrayal. While a woman’s relationship with her OBGYN is extremely beneficial, there are times when it can become necessary to look for additional support and resources. Complex GYN conditions — such as fibroids, endometriosis, and polyps — can be diagnosed by an OBGYN, but, often, they lack sufficient experience or training in advanced minimally invasive techniques for hysterectomy, myomectomy, or endometriosis excision. As a result, many women unnecessarily undergo more invasive procedures. When surgery is necessary, unless the OBGYN is fellowship-trained in advanced laparoscopy, it could be time to seek a second opinion from a GYN surgical specialist.


An OBGYN knows some of the most intimate details of your body, and you may feel unsure that another provider could know the ins and outs of your health as well. This isn’t a problem if you find yourself in good health. However, if you’re suffering from symptoms such as anemia due to heavy bleeding, pelvic pain, difficulty going to the bathroom, pain with sex, or infertility, you could be suffering from endometriosis, fibroids, adenomyosis, ovarian cysts, or polyps. These conditions may require surgery for treatment. When surgery is recommended, it’s important to get specific and ask important questions related to your symptoms, and always seek a second opinion for a precise diagnosis and available treatment options.


If you have been diagnosed with a complex GYN condition, there are questions provided by The Center for Innovative GYN Care (CIGC) that you can ask to help determine if your OBGYN is qualified to surgically treat your condition. Asking the following questions, and having an idea of what the answers should be, can help you decide if you need a second opinion.

Do you have fellowship training in minimally invasive GYN surgery?

Fellowship-trained GYN surgeons devote their career entirely to minimally invasive surgery, and do not perform obstetrics. Fellowship training in laparoscopy means he or she has had extensive experience diagnosing and treating complex conditions using advanced minimally invasive techniques.

How would you perform the surgery? (Myomectomy, hysterectomy, ovarian cystectomy, or pelvic adhesion removal)

Many non-specialists perform open abdominal procedures for GYN conditions. These have large incisions, are more painful, and can take up to two months to recover. The long recovery can have a negative effect on your emotional well-being, employment, and income if long-term disability results. Standard and robotic laparoscopic procedures also present longer recoveries and higher risks to patients than CIGC techniques. On average, CIGC patients who have had a hysterectomy, endometriosis excision, or ovarian cyst removal are back to themselves in about one week. CIGC myomectomy patients recover in about 10–14 days.

How long do you anticipate the procedure taking? 

The longer the procedure takes, the higher the risks to the patient. Serious complications can result from blood loss and being under general anesthesia for longer periods of time. Robotic procedures can take two to four hours on average. Standard laparoscopy can take two hours, and open procedures can take one to two hours on average. On average, a CIGC DualPortGYN hysterectomy is less than an hour (54 minutes). A CIGC LAAM myomectomy procedure is just over an hour (74 minutes).

How long will the recovery time be? 

Open GYN procedures can require a patient to stay up to a week in the hospital. Standard and robotic procedures often require at least an overnight stay in the hospital and can require an additional three-to-five-day stay. Advanced procedures at CICG are performed in an outpatient setting, which means that patients return home the same day and recover in the comfort of their own homes — reducing the risk of hospital-related infections.


“When it comes to GYN surgery, patient volume is crucial,” said Paul MacKoul, MD. “Low-volume surgeons may not have enough experience with complex conditions, which can put patients at risk.”

According to the American College of Obstetricians and Gynecologists (ACOG), an OBGYN performs an average of 27 hysterectomy procedures a year. Many of these procedures are performed as open surgeries, specifically for large fibroids or an enlarged uterus. The definition of a high-volume surgeon is that he or she must perform a minimum of 51 hysterectomy cases per year.

Dr. Paul MacKoul continues, “The benefit of a high-volume laparoscopic GYN specialist is that he or she is exposed to more complex cases and maintains a level of practice that ensures they are performing at a high skill level. It has been shown that lower-volume surgeons have a higher risk of complications due to the techniques used and the frequency of the surgeries performed.”

The advanced specialists at CIGC perform hundreds of hysterectomy cases annually. On average, CIGC surgeons perform 2,000 laparoscopic GYN surgeries annually, including hysterectomy, myomectomy, endometriosis excision, pelvic adhesion removal, and ovarian cystectomy. CIGC provides high-skill and high-volume laparoscopic surgeries that contribute to an incomparable level of expertise.


To treat complex GYN conditions, the CIGC co-founders developed the DualPortGYN® and LAAM® fibroid removal for fertility techniques. Leveraging advanced minimally invasive approaches controls blood loss and maps the pelvic cavity for clear visualization — providing better outcomes for women. These make treating complex conditions like an enlarged uterus, fibroids, ovarian cysts, pelvic adhesions, and endometriosis possible.

Our minimally invasive GYN surgeons can perform DualPortGYN laparoscopic procedures for hysterectomy, endometriosis excision, pelvic adhesion resection, and ovarian cystectomy, using two tiny 5 mm incisions that are placed between the major abdominal muscles. One incision is placed at the belly button and one is placed just above the pubic bone and are smaller than a paper cut.

LAAM was created as a hybrid procedure for uterine-sparing fibroid removal that uses one 5 mm incision at the belly button, and a 3 cm incision at the bikini line. For finding fibroids, this ultra-minilaparotomy procedure makes it possible to find undetected fibroids and remove them thoroughly.

Compared to open procedures that require up to two months for recovery, CIGC patients recover from a DualPortGYN hysterectomy in one week and recovery for a LAAM myomectomy is 10–14 days.


Fibroids, endometriosis, pelvic paininfertility, and other GYN conditions deserve specialist care.

Anne, a CIGC patient, turned to her GYN for treatment of fibroids, but wasn’t offered the surgical intervention she needed. Even after getting a second opinion, she was only offered an open procedure that would take six to eight weeks to recover from. Anne needed a specialist.

“Thinking long term, I knew I should do something about this, but, in the short term, it was scary and not something I wanted to do. So, I started looking online. I was looking for anyone who had had a positive experience with this surgery, thinking maybe it wouldn’t be that bad. I didn’t find anyone on the local message boards, but that’s when I found The Center for Innovative GYN Care.”

Anne discovered that a laparoscopic myomectomy without a robot was possible. At CIGC, Anne was able to have her fibroids removed with our minimally invasive myomectomy. Now, she’s not just feeling back to normal — she’s feeling better than ever.

“I didn’t realize how uncomfortable I was until after I had the surgery. I’m a runner. I literally feel like a concrete block has been removed from my abdominal area.”

CIGC is dedicated to providing the best care available to women suffering from complex GYN conditions. CIGC minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD, and Dr. Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind. Learn more about the ways CIGC state-of-the-art specialists can help you take control of your health. Book a consultation to explore your options today.

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