The Kaldas Center Blog Women's Health News

Laparoscopic Surgery Myths: Q & A with Dr. Kaldas

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Dr. Kaldas answers tough laparoscopic surgery myths. If you have any questions, please contact us to learn more (920) 886-2299.


Q. Laparoscopic surgery is still a fairly new technology

A. False.  Laparoscopy has been around for over 100 years.  But it was only in the 1980’s that I was privileged to be mentored by the pioneer who first ever placed a camera on the laparoscope while I was at Stanford.  He was the first to connect a laser to the laparoscope too.  And now I am privileged to mentor Dr. Menya in laser laparoscopy.  It has become part of our identity to heal with the laser through minimally invasive surgery.  To heal, and to heal well every time.

What confuses people is the variable learning that OB/GYN’s have had.  Being able to catch a baby does not qualify us to be laparoscopic surgeons.  In fact, most of the time the opposite is true.  When you think of it, catching a baby is a totally different skill set than advanced operative laparoscopy.  But the baby doctor doesn’t tell their patient that, and then complications arise or the wrong kind of surgery is done or an inadequate surgery is done.  It can be really frustrating for the patient.  The patient has a right and an obligation to herself and her loved ones to find the best doctor for laparoscopic healing.  She shouldn’t feel guilty about it if it is not the one who delivered her babies.


Q. Laparoscopic surgery is done by a robot

A. False.  The robot is an instrument, just like a scalpel or a laser.  It will not make a good surgeon out of a bad surgeon.  It is simply another instrument and if that is the instrument of choice for a surgeon, they must apply themselves to become very good with it. Otherwise, they will cause injury and more harm than good as with any instrument.  Because the Kaldas Center surgeons are so gifted at laparoscopy, the robot actually can hold us back.  Leonardo DaVinci did not paint the Mona Lisa with a robot.  It was his hand and his eye that created the masterpiece.  Most technologies, to be useful, need to be better, faster, and cheaper.  For the Kaldas Center laparoscopic surgeons, we are fortunate to be better, faster, and cheaper with less pain and recovery time for complicated situationions when we do not use the robot for our surgeries.  For other surgeons the robotic assistance may help them, and they should use it then.


Q. Patients with endometriosis cannot be treated by laparoscopy

A. False.  For the skilled laparoscopist, this is the surgical treatment modality of choice.  It truly breaks my heart to see what women with endometriosis have gone through sometimes before finding the Kaldas Center.  We make it our obligation to be the very best laparoscopic healers of endometriosis, bar none.  These ladies, often trying to conceive, have had ovaries cutout, been cut open, had parts of their bowel taken out.  Sometimes they are even mislead into having hysterectomies.  “No other choice” they are told.  Sad, sad.  And even then they do not get pain relief because a hysterectomy is done but the endometriosis is left behind because the surgeon doesn’t know how to do that safely.  Then they are in pain and can’t have children and the mistreatment is depressing.


Q. Any OB/GYN can perform laparoscopic surgery

A. False.  If someone has not been taught and mentored thoroughly, the laparoscope can be wielded as a weapon that does much harm rather than a tool for doing good by people.  I believe 80-90% of the confidence to do surgery comes after the formal residency training is completed.  Thus, it is so essential to have qualified mentors, otherwise new doctors never achieve confidence through competence if the older doctors themselves never learned how to do laparoscopy well.  Women have a choice.  They can seek gifted, compassionate care for their changing needs and not feel guilty if that is found elsewhere than the clinic or health system they’ve been going to.


Q. Your weight affects your ability to have laparoscopic surgery

A. False.  Many reports state that being very heavy may affect the ease with which laparoscopy may be done, however, with the right surgical skill and the wisdom to know if you have what it takes to help a particular patient, it is still way better than being cut open. If you do not have a very well taught and gifted surgeon, you will be poorly served regardless of the approach taken:  laparoscopic, open, or robotic, with dreadful and expensive complications resulting.


Q. If a patient has previously had abdominal surgery, they are not a candidate for laparoscopic surgery

A. False.  It depends on the skill, ability, and desire of the doctor to do right by the patient.  Sadly, most GYN surgeons say things like this because they are uncomfortable with their own laparoscopic surgery skills and do not want to acknowledge that.  Sometimes patients are guided to what the doctor knows how to do, rather than what may be the best option available in the community for the patient’s needs.

We are so blessed to get many patients from other GYN doctors that find us on there own.  Since all OB/GYN Surgeons are primary care doctors by state and federal law, no referrals are needed to be seen by Kaldas Center doctors.


Q. If a patient has a large ovarian cyst or fibroid, they are not a candidate for laparoscopic surgery

A. False. Unless the cyst is or fibroid is over about 15 centimeters (about 7 inches) it can be removed in a safe, contained manner with day surgery through tiny incisions.  It is through the knowledge, skill, and wisdom of the surgeon that they can be confident before ever doing surgery how likely a cyst or mass is to be cancerous.  The GYN surgeon should guide patients to the safest surgery choice, or refer the patient to someone in the community who can provide the safest surgery choice.  It is a routine now to have patients find us who have been referred to Milwaukee or Madison for surgery by their prior OB’s and then find out we are doing the most advanced laparoscopic surgery anywhere right here at the Kaldas Center.


Q. A hysterectomy cannot be done through laparoscopic surgery

A. False. I was the first one to do a total laparoscopic hysterectomy in Northeast Wisconsin in the late 90’s since I was fortunate to be taught how to do so in my residency.  Most residencies at the time simply did not teach that.  They have been done by my mentors at Stanford and a handful of other pioneer GYN surgeons in the field since the early 90’s.  The key is to have the wisdom to look at the whole picture, and understand that hysterectomy is not the cure for everything.  I’ve seen it all I think, such as patients who have laparoscopic hysterectomy for the uterus falling out and nothing else.  Well, they come back and the vagina is still falling out because that was not the right treatment in the first place.  Same happens all the time with endometriosis treatment and urinary incontinence surgery.


Q. Laparoscopic surgery means less recovery time

A. True. If done without complication and done to achieve the goals of the patient.  I’ve had patients who have desk jobs go back to work in as little as 2 days after major laparoscopic surgery.  If done the old fashioned way, they would have probably been in the hospital still with a big painful incision on their abdomen.  If complications arise during laparoscopy, then recovery is as long as when complications arise with any approach, such as open or robotic.  We hope and pray on Sunday; the rest of the time it is our obligation to know what we are doing and do it uncompromisingly well and with professional honesty.


Q. Anyone is a candidate for laparoscopic surgery

A. True and False. Almost anyone.  Some folks are not.  If the person cannot be ventilated because of a combination of being very, very large and history of respiratory issues such as heavy smoking or asthma, then the required inflation of the abdomen is not possible and they are not candidates for laparoscopy.  I’ve done laparoscopy on very large people with body mass index in the 70’s, and those who have smoked a lot, but a combination of the two makes it tough for anesthesia to ventilate these ladies when they are tipped to get the bowels out of the pelvis while they have CO2 gas in the belly so we can see.  The rest depends on the surgical capability and wisdom in surgical decision making.


With battling infertility for years, Dr. Kaldas made our dream come true! We had tried to get pregnant naturally for about 2 years. We then decided to seek medical help. After multiple unsuccessful medicated cycles and multiple failed intrauterine inseminations (IUI) and multiple doctors we were finally referred to Dr. Rami Kaldas. After meeting Dr. Kaldas for the first time, we had regained our hope in achieving our dream of having a baby. We were distraught and lost after dealing with infertility for the past 3 years, but Dr. Kaldas gave us that newfound hope. He gave us reassurance and helped reduce our stress and anxiety. After only 2 months of being treated by Dr. Kaldas, we were pregnant! He is a true professional in his field! We are very thankful to have met Dr. Kaldas. During our pregnancy he was still by our sides ensuring the successful delivery of our little one. He is very dedicated, knowledgeable and committed to each of his patients. The night I went into labor he had worked an entire day, stayed the entire night and worked the following day as he had multiple other deliveries and appointments to keep. He is very driven and dedicated to his patients and it shows. No amount of thanks will ever be enough. I highly recommend Dr. Kaldas to anyone dealing with infertility or pregnancy!

Sarah / Menasha, WI