Dr. Paul Tyan

Patient Feedback

Patterns Across Patient Feedback

Endometriosis Focus

Endometriosis Is a Main Focus, Alongside Regular OB/GYN Care

Dr. Tyan is a minimally invasive gynecologic surgeon, meaning surgery is done through small incisions rather than large ones. Endometriosis and chronic pelvic pain are described as a main focus. The stated approach is excision only, which means cutting endometriosis out rather than burning it off, and iCareBetter has video-vetted this surgeon for excision. The reported surgical volume is more than 200 surgeries a year and more than 1000 complex cases so far, with none ever having to be switched from a minimally invasive approach to open surgery.

Alongside this, the practice still handles regular obstetrics and gynecology, including high-risk pregnancy, prenatal care, and deliveries. So endometriosis surgery is one part of a broader women's health practice rather than the only thing offered. Some directories show endometriosis as treated more often here than at similar practices, but that number comes from insurance billing codes, so it reflects how often it is treated, not whether the surgery is specifically excision.

Multidisciplinary Approach

Works With Bowel and Bladder Surgeons, and Pelvic Floor PT

For advanced disease that has spread, a colorectal (bowel) surgeon joins the operation, and the described work ranges from small bowel repairs to removing a section of bowel when needed. Work on the ureters, the tubes that carry urine from the kidneys to the bladder, is handled directly, and a urologist is brought in when endometriosis has grown into the bladder. Surface endometriosis on the diaphragm, the muscle below the lungs, is within scope, but anything deeper into the diaphragm is not done. Outside of surgery, the practice works with a network of pelvic floor physical therapists and offers trigger point injections to some patients. Nancy's Nook notes that a full team is available when needed.

Diagnosis Methods

Uses MRI for Complex Cases, and Will Operate When Symptoms Point to Endo

When advanced or widespread endometriosis is suspected, an MRI is ordered before surgery to see how far it has spread. Patients who already had an exploratory surgery with a non-specialist but still have symptoms are encouraged to consider another surgery, since endometriosis is often missed when it does not look like the classic dark spots. For patients earlier in the process, accounts describe a diagnosis based on symptoms at the first visit, usually followed by imaging and then surgery. What counts as enough to rule endometriosis out, rather than confirm how far it reaches, is not clearly spelled out in public sources.

Educational Presence

Vetted and Active in the Endo Community, but Little Endo Research on Record

The clearest public presence on endometriosis is through iCareBetter, where this surgeon was the first to pass his video review and was the featured guest in a 2023 interview about that vetting process, the approach to care, and when medication is used alongside surgery. A patient-education article written for the Inova Newsroom in 2021 describes endometriosis as a common and often-missed cause of chronic pelvic pain and infertility.

On social media, a Capital Women's Care practice account posted a welcome introducing the new surgeon, which was made by the practice rather than run personally, and a personal Instagram account is set to private.

The research record is large overall, with more than 35 published papers and book chapters, but only one is specifically about endometriosis: a 2017 surgical video showing a team removal of deeply rooted endometriosis, written with a mentor. The rest focuses on minimally invasive gynecologic surgery and hysterectomy outcomes in general, not endometriosis. Board certification in obstetrics and gynecology and membership in the American Association of Gynecologic Laparoscopists are confirmed.

One note on the training: the official fellowship was a general minimally invasive gynecologic surgery fellowship, not one focused only on endometriosis. Both the fellowship director at the University of North Carolina and the residency research mentor at George Washington University are well-known endometriosis specialists, and jointly published papers with each confirm these were real working relationships, not just a name on paper.

Post-Surgical Care

Recommends Hormonal Suppression and Treats Pain as Part of a Longer Plan

After surgery, the usual recommendation is a combination birth control pill to keep symptoms suppressed, or a progesterone-only option if a combination pill is not safe for the patient. Patients are told before surgery that removing the endometriosis is only one part of the plan, and that some will still have symptoms afterward that need more care.

For pain that continues, the described tools include certain nerve-calming medications (types called SSRIs, SNRIs, or GABA-analogs) for pain that has become long-standing and amplified, along with pelvic floor physical therapy, muscle relaxers, and trigger point injections or nerve blocks for tight pelvic muscles. Patient accounts describe a first check-up about two weeks after surgery, sometimes with another visit scheduled after that.

Philosophy and Fit

Favors Early Excision, Protects Fertility, and Avoids Defaulting to Hysterectomy

His stated view is that endometriosis is a complex disease with more than one cause, shaped in part by genetics, and not something that simply blocking periods or suppressing hormones can cure. Treating it early is emphasized, especially when the disease is deeply rooted, on the belief that waiting can make outcomes and quality of life worse.

His approach is openly skeptical of offering a hysterectomy as the only option, pointing out that some patients who have a hysterectomy for pelvic pain still have endometriosis left behind and need it removed later. For patients who may want children or want to keep their uterus, the stated goal is to work carefully to avoid harming the fallopian tubes or reducing the ovaries' egg supply. Care is offered in several languages, including English, French, Arabic, and medical Spanish.