Interview: Dr. Ramon Yera, MD on Tissue Containment, Surgical Adoption, and the Reality of Modern Gynecologic Surgery

Dr. Ramon Yera, MD is recognized as one of the world’s most innovative surgeons in minimally invasive gynecologic surgery, with 35+ years of experience and thousands of laparoscopic procedures performed.

A key architect of Kaiser Permanente’s Minimally Invasive GYN Surgery Program, he operates nationwide, mentors surgeons across the U.S., and serves as a trusted key opinion leader in surgical innovation.

We spoke with Dr. Yera about how gynecologic surgery has evolved since the FDA’s black box warning on morcellation, and what surgeons need today to deliver safe, minimally invasive care in real-world settings.

Q: Can you start by telling us about your background and your current surgical practice?

Dr. Yera: I am a minimally invasive gynecologic surgeon, and for the past 15 years I have focused exclusively on complex minimally invasive surgery. I no longer see patients in a traditional clinic setting. I operate every day.

My role today is somewhat unique. I work with surgeons across the country who may not have the specialized skill set to perform complex gynecologic procedures in an outpatient setting. Together, we are able to offer patients same day surgery with faster recovery and a better overall experience.

I operate throughout the United States, including regular surgical weeks in Alaska, monthly cases at Kaiser Fresno, which is a program I helped build over 20 years ago, and with multiple surgical teams across Southern California. In parallel, I serve as a mentor, educator, and key opinion leader, working with industry on surgeon training, research, and product development.

Q: In 2014, the FDA issued a black box warning on power morcellation due to concerns about the spread of undiagnosed malignancies. How did that change gynecologic surgery in practice?

Dr. Yera: Before the black box warning, morcellation (the surgical technique of cutting large tissue, such as the uterus or fibroids, into smaller pieces for removal through minimally invasive incisions) was often performed without containment. In rare cases where an undiagnosed sarcoma (malignant cancer) was present, morcellation could upstage the disease, which raised serious safety concerns.

As a result, many hospitals and surgery centers reassessed their risk exposure. Power morcellators were removed from shelves in many facilities, largely due to liability concerns. That forced surgeons into less optimal alternatives, including open surgery, even when a minimally invasive approach would have been preferable for the patient.

This created a real gap. Surgeons still needed to remove large specimens minimally invasively, but they also needed a way to do so safely and responsibly.

Q: What challenges do surgeons face today when it comes to tissue containment?

Dr. Yera: One of the biggest challenges is usability. Many containment systems require a significant learning curve and frequent use to maintain proficiency. But most surgeons do not use containment bags every day. Sometimes it is monthly or even less frequent.

When a device is difficult to deploy or unfamiliar, it becomes a barrier to adoption, even when surgeons fully understand the importance of containment. Practicality matters just as much as intent.

Q: What stood out to you when you started using LapBox?

Dr. Yera: There are three things that really matter in daily practice: ease of use, integrity, and size.

First, ease of use. The learning curve is minimal, which makes a big difference for surgeons who do not use containment systems daily.

Second, integrity. The double wall construction creates a protective air pocket between layers, making perforation or leakage extremely unlikely, even when power morcellation is used. From a safety standpoint, that is a significant advantage.

Third, size. The bag is large enough to accommodate most specimens we encounter, which means one solution can be used across multiple procedures.

“LapBox stands out because it combines ease of use, structural integrity, and size. The learning curve is minimal, the double-wall design makes leaks extremely unlikely, and the bag is large enough to handle most specimens, allowing both manual and power morcellation safely in today’s post-FDA-warning environment.”

Q: In which procedures is containment particularly important?

Dr. Yera: Hysterectomy is a bread and butter procedure, and uterine size can vary significantly. Having a containment system that can handle that variability is critical.

The same applies to supracervical hysterectomies, laparoscopic myomectomies where multiple fibroids need removal, and large ovarian masses that appear benign but cannot be fully ruled out preoperatively. In those borderline cases especially, containment allows specimens to be removed safely without spillage.

Q: How do you see adoption of containment systems evolving?

Dr. Yera: Once a system is integrated and surgeons start using it, the value becomes very clear. When a device is intuitive, reliable, and adaptable across cases, it naturally becomes part of standard practice.

“Once surgeons use LapBox, they realize this is the bag they should be using for their bread-and-butter procedures.”

Containment is no longer optional. It is an expectation. The question is whether the tools we give surgeons make compliance realistic in everyday surgery.

Q: Any final thoughts on where the field is heading?

Dr. Yera: In today’s surgical environment, solutions need to balance safety, efficiency, and real world usability. When those elements come together, adoption follows, and ultimately, patient care improves.