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Doctor Advocates Less Invasive

Dr. Paul MacKoul, a McLean resident, is on a mission. Since doing his residency 12 years ago, MacKoul has been perfecting a technique that uses laparoscopic surgery to treat gynecologic conditions when other doctors would turn to open surgery.

He says laparoscopic surgery could be more widely used to treat women suffering from ovarian cancer, endometriosis, fibroids and other gynecologic conditions with less pain, decreased hospital stays and faster recovery times.

LAPAROSCOPIC SURGERY uses a small incision in the abdominal wall. A laparoscope is used to allow the surgeon to see inside the abdomen or pelvis. By using laparoscopy, MacKoul creates four tiny incisions as opposed to one 30-centimeter incision.

“A patient does not need to go through all that, especially a cancer patient,” said MacKoul, director of gynecologic oncology at Capital Women’s Care. “I’m doing the same surgery but with smaller incisions.”

MacKoul said he is one of six or seven doctors in the Washington, D.C.-metropolitan area specializing in gynecologic oncology care, but the only one using laparoscopy routinely for cancerous and precancerous conditions.

He said the difference between the two surgical techniques is the time factor. With open surgery, a doctor can complete the procedure in 45 minutes and the patient has a six- to eight-week recovery time. Laparoscopic surgery could take as much as three hours, but it can be done on an outpatient basis with patients returning to work the next day. He said using laparoscopy to treat gynecologic conditions has been proved in other parts of the United States but has yet to become common practice in this area.

“There are a lot of people doing it routinely. It is just as effective as open surgery,” MacKoul said. “In probably five years, it will be routine.”

HE BELIEVES the reason is a resistance to change. Doctors would need more training to learn to perform laparoscopic surgery in this manner. Insurance companies, he said, already approve such surgery because it uses recyclable equipment and its reduces recovery times.

“I get referrals all the time,” MacKoul said, “because patients are going home faster and the insurance companies are paying less money.”

MacKoul said patients need to be their own advocates and seek a second opinion when informed they need invasive surgery.

“Doctors need to get out of the business end of medicine and get back to treating the patient first,” he said.