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In 2002, the Essure procedure was being performed for elective sterilization in other states, but in New Mexico it was unknown. Dr. Garcia was faced with the challenge of educating the medical community about the procedure and then getting it approved by local insurance companies. The Essure micro-insert coil is made of a titanium-nickel alloy with a synthetic fiber core. This spring-like device is designed to anchor within the fallopian tube. The inner fiber core causes tissue scarring that occludes the fallopian tube over a period of three months, preventing pregnancy. After these three months, an x-ray is done to show that the coil is still permanently placed and that the tubes are blocked. Then the patient can rely on the Essure for permanent contraception. There have been more than 50,000 procedures performed worldwide, with a 99.74% effectiveness rate at preventing pregnancy. The procedure is a good choice for most women, Dr. Garcia says. Dr. Garcia began performing the Essure procedure in 2004. Shortly after, she became certified as an Essure Accredited Physician and began training other gynecologists in New Mexico and around the country. In 2005, Dr. Garcia opened the Center for Women’s Surgery in Albuquerque. This gave her the freedom to perform hysteroscopic procedures such as Essure in the office. “When I give my patients the choice of having the procedure in the operating room or in my office, all of them choose the office,” says Garcia. The only Essure Accredited Practice currently in New Mexico is the Center for Women’s Surgery. As a national leader in the field of minimally invasive surgery, Garcia was one of the first physicians in the country to perform the procedure in the office. She has now performed more than 80 in-office Essures and has instructed others in more than 100 cases. “I feel fortunate to have an amazing support staff,” says Garcia. “My assistant and I are now able to perform the Essure in less than 10 minutes. My patients report they are comfortable and return to their usual activity almost immediately.” The only common side effect is slight cramping. Hysteroscopic sterilization is just one of the minimally invasive procedures performed by Dr. Garcia, who treats a variety of common gynecological problems with leading-edge techniques. The laparoscopic supracervical hysterectomy is one of the other specialized surgeries she performs. One hysterectomy patient, Kathryn, testifies, “I was up at 6 a.m. the day after my surgery. I cleaned the bathroom by 9 a.m., did laundry, showered, cooked a big dinner, and basically went about my day, almost as if I hadn’t had surgery the day before—all without pain medication.” If Kathryn had had abdominal surgery for her hysterectomy she would have needed six to eight weeks to return to a normal routine. But two weeks after her surgery, Kathryn was given the green light by Dr. Garcia to continue her regular exercise program, which is common with laparoscopic procedures. Laparoscopic surgery is where a small lighted camera and special surgical instruments are inserted through tiny incisions into the abdomen. Many gynecological surgeries, including hysterectomies, can be performed with these tiny incisions. If the surgeon is well trained, there are generally fewer risks associated with laparoscopic surgery. The recovery is quicker because the incisions are smaller than those of traditional surgeries. “Women do better and heal faster,” Dr. Garcia says. “They get back to their lives sooner.” Susan, a registered nurse, chose Dr. Garcia to be her surgeon because of the doctor’s warmth and approach to patient care and education. “The atmosphere at the Center for Women’s Surgery provides is very comforting.” Susan says. “And Dr. Garcia takes the time to listen and explain her diagnoses in detail.” Susan says of Dr. Garcia, “She is very knowledgeable, calming, and reassuring. She de-stresses everything, and you go away really understanding what your options are.” Dr. Garcia says she is able to spend more time with patients because she is focused on gynecologic surgery only, and not on more routine care offered by other gynecologists and primary care providers. During a patient consultation, Dr. Garcia thoroughly explains procedures and options. She educates her patients further with her hand-drawn sketches of the organs related to the individual patient’s case, which clearly illustrate both Dr. Garcia’s diagnosis and the patient’s treatment options. Dr. Garcia gives her patients a copy of these sketches and notes, instructing that each patient consider what she’s heard before making a decision to schedule surgery.
The most common reason for a woman to have a hysterectomy is pain and/or bleeding, and the most common cause of these complaints is fibroids - benign tumors of the uterus. Dr. Garcia sees many patients with uterine fibroids, and says performing a hysterectomy to treat fibroids is one of the most difficult surgeries she performs. Large fibroids distort the anatomy and traditionally require a large abdominal incision to remove. Dr. Garcia eliminates the need for a large incision by using a laparoscopic circular blade to remove the uterus in long strips of tissue. This procedure is less invasive, but takes more time than traditional surgical techniques. With the supracervical hysterectomy, removal of the uterus occurs above the cervix. As long as a woman has a history of normal pap smears and continues to get pap smears, Dr. Garcia can remove just the part of the uterus above the cervix which is causing all the problems. Because large ligaments attach to the cervix, supracervical hysterectomy has the benefit of preserving the woman’s pelvic support, resulting in fewer instances of bladder and vaginal vault prolapse. Maintaining normal vaginal anatomy is an important issue for women’s health. Removing ovaries is not part of the hysterectomy procedure. “I am a huge advocate for keeping ovaries as long as they are healthy and normal,” Dr. Garcia says. She says new evidence indicates that even in menopause, when women’s ovaries stop making estrogen, ovaries continue to produce other beneficial hormones that are converted into estrogen, decreasing a woman’s chances of dying from coronary artery disease. Laparoscopic supracervical hysterectomy takes more time and is more difficult, but Dr. Garcia is willing to take the time so her patients can reap these eight benefits: having an option, keeping an important part of the uterus, keeping tissue and ligaments that support the cervix, preserving vaginal anatomy, retaining hormonal function, causing less pain, reducing recovery time and decreasing surgical risks. The Center for Women’s Surgery also offers several alternatives to hysterectomy for women with fibroids, including two procedures–the hysteroscopic myomectomy and laparoscopic myomectomy—in which Dr. Garcia removes just the fibroids, leaving the uterus intact. Women who have heavy, life-affecting menstrual cycles, but no fibroids, can avoid hysterectomy by choosing a treatment called endometrial ablation, which destroys the uterine lining. While it doesn’t work for every woman, and some do go on to have a hysterectomy, endometrial ablation restores normal periods for most women—seven out of 10 avoid hysterectomy through this procedure, Dr. Garcia says. She also performs surgery for urinary incontinence—a straightforward, outpatient procedure, she explains, which works immediately. Since Dr. Garcia specializes in minimally invasive and laparoscopic gynecological surgery techniques, orienting the surgical staff at Presbyterian Hospital to her operating procedures has been a significant part of her work. Though training is an ongoing process, the staff has now assisted and performed hundreds of these surgeries, and Dr. Garcia says she has an excellent team committed to the process of laparoscopic and other minimally invasive surgeries for women. Surgery is not usually something to look forward to. But an interview with patients indicate Dr. Garcia nurtures and builds a patient-doctor relationship that is relaxing and confidence-building at the same time. Patients say they feel they are in good hands, and Dr. Garcia has many satisfied patients like Kathryn and Susan. Board-certified in obstetrics and gynecology, and fellowship-trained in minimally invasive gynecologic surgery, Dr. Garcia is a board member of the American Association of Gynecologic Laparoscopists, a Fellow of the American College of Obstetrics and Gynecology and an Assistant Professor at the University of New Mexico Department of Ob/Gyn. She is a Certified Essure Preceptor with an Essure-Accredited Practice. A native of Albuquerque, Dr. Garcia received her undergraduate degree in biology and attended medical school at the University of New Mexico. She completed her residency training in OB/GYN and her fellowship at the University of Illinois at Chicago. Dr. Garcia’s mentor during her time at the University of Illinois was Dr. Andrew Brill, an internationally recognized expert in the field of minimally invasive surgery. Like so many other professional women, Dr. Garcia says it’s difficult to find time for everything, but she enjoys painting, and several abstract paintings she has done are hanging on the walls at Center for Women’s Surgery. She loves spending time with her 2-year-old son and is working on a screenplay about life in the field of medicine. She will soon be rafting down the Grand Canyon. Center for Women’s Surgery |
Currently, the only FDA-approved device for hysteroscopic sterilization is the Essure coil. “I first saw this device during my fellowship training,” explains Garcia. “I thought it was one of the most innovative procedures I’d ever seen. I was most impressed with its potential to offer women a very low-risk option for permanent contraception.” 
Dr. Garcia schedules a 30-minute pre-operative visit with each patient to discuss potential risks, what to look for if there is a complication, and other concerns the patient may have regarding surgery. “Dr. Garcia has an excellent bedside manner,” Susan says. “She truly empathizes with her patients.” As an RN, Susan knows that Dr. Garcia is committed to her relationships with her patients. “She held my hand as they wheeled me in to the OR, and called me at home after my surgery,” Susan says.