Dr. Seckin’s Lecture on Uterine Abnormalities at the First Ever, “Global Congress on Hysteroscopy”

Earlier this month on May 5th, our founder, Dr. Tamer Seckin, spoke at the Global Congress on Hysteroscopy in Barcelona, Spain. This was the first ever meeting of the Congress that looked to discuss the findings of several board certified hysteroscopic surgeons across the globe, in order to see what these new discoveries can hold for the future of obstetrics and gynecological medicine. Dr. Seckin’s lecture, entitled “Hysteroscopic Findings During Endometriosis Surgery,” looked to discuss uterine anomalies and their effect on endometriosis.

hysterectomy congress, full pathology report

Endometriosis is a disease of menstruation that originates from the uterine cavity and spreads to ectopic regions. For this reason, Dr. Seckin looks to examine the uterine cavity for malformations using hysteroscopy, in nearly each endometriosis surgery he performs. Uterine abnormalities are defined as any structural abnormality found in a uterus, which usually can have negative effects on uterine function, leading to both obstetric (infertility, miscarriages, etc.) and gynecological (endometriosis) issues. Therefore, uterine malformations is a highly important field of study amongst the hysteroscopy community. However, due to the wide range of different uterine anomalies, these studies can vary in their findings.

Arcuate uterus is a subcategory of one of the most common forms of uterine malformations, septate uterus. Septate uteri are defined by a cavity-dividing uterine septum, which derives from narrow indentation of the fundus (top of the uterus) into the uterine cavity. Arcuate uteri are characterized by the same concave dip of the myometrium of the fundus into the uterine cavity but in a more subtle form. But how does one make the distinction between these similar abnormalities? This brings up precisely where the conflict lies. In fact, most countries, which includes most of Europe, simply do not make the distinction between septal and arcuate uteri. This may seem logical at first glance, as studies have shown arcuate uteruses does not play a significant role when it comes to cases of fertility, miscarriages and other obstetric issues, whereas patients with a septate uteri have a higher chance of miscarriage and overall infertility. However, some studies have shown that arcuate uterus, when explicitly defined, may play a role in certain gynecological conditions. For this reason, Dr. Seckin looks to examine the effect of arcuate uterus and the role it plays in his endometriosis patients at his Seckin Endometriosis Center.

In a study that consisted of 260 endometriosis patients that received a hysteroscopy over the course of 2 years, 100 of these patients were found to have arcuate uterus, as defined by a previous study, which categorized arcuate uteri from septal uteri if the fundus did not exceed 1.5cm of indentation. The other 160 patients were ruled to have a normal uterine structure. While this only accounts for 38% of the patients, this is significant data in comparison to the 3.8% of the general population that were found to have arcuate uterus in a study published by Chan et al [ 1 ]. In other words, there seems to be a much higher prevalence of patients with arcuate uterus in cases of endometriosis versus that in the general population. This brings up a key question: Could arcuate uterus play a causal role in the development of endometriosis? Based on this information, it certainly poses a possibility.

arcuate uterus was found to be in 38%
In a study of 260 hysteroscopy cases, arcuate uterus was found to be in 38% of these endometriosis patients, which is significantly higher than the 3.8% found in normal population.

On top of this, Dr. Seckin’s surgery team utilizes an excision of endometriosis technique that allows for a full pathology report to be obtained for each patient. Using these reports, Dr. Seckin and his team looked to use the data on the number of specimens that were pathologically confirmed to be endometriosis lesions. Of the 100 arcuate uteri endometriosis patients, 39 were confirmed to be positive for endometrioma development (39%). This was much larger in proportion to the 38 positive endometriomas out of the 160 normal uteri endometriosis patients (24%). This meant that having a uterine anomaly, specifically arcuate uterus, brought a 1.76 fold greater chance of ovarian endometrioma presence, which can even lead to multiple organ involvements and the presence of stage 3 or 4 endometriosis. Thus Dr. Seckin’s study concluded two main findings.

First, patients with an arcuate uterine cavity have a statistically higher number of specimens that are positive for endometriosis versus those with a normal uterine cavity. And second, patients with an arcuate uterine cavity will also have a higher chance of pathologically testing positive for an endometrioma, than those with a normal uterine cavity. So, how can this information play a role in the future of endometriosis treatment?

Well first and foremost, making the distinction of arcuate uterus from septate uterus is crucial to note as it shows that what one uterine abnormality may mean for an obstetric patient, may be different than for cases of endometriosis. Thus, identification of whether or not a patient has arcuate uterus through hysteroscopy should be a key step in any endometriosis surgery case. It also raises the idea that a potential resection of midline prominence and restructuring of the uterine cavity to its normal anatomical structure, may be a significant step for surgical treatment of endometriosis patients.

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References

  • Chan Y, Jayaprakasan K, Zamora J, Thornton J, Raine-Fenning N, Coomarasamy A. “The Prevalence of Congenital Uterine Anomalies in Unselected and High-Risk Populations: A Systematic Review.” Hum Reprod Update. 2011;17(6):761-771

 

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Patient Reviews

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  • Rebecca Black

    Fast forward 5 years to find out incidentally I had a failing kidney. My left kidney was only functioning at 18%. During this time, I was preparing all my documents to send to Dr. Seckin to review. However, with this new information I put everything on hold and went to a urologist. After a few months, no one could figure…

  • Monique Roberts

    I'll never stop praising Dr. Seckin and his team. He literally gave me back my life.

  • Erin Brehm

    I had a wonderful experience working with Dr. Seckin and his team before, during and after my surgery. I came to Dr. Seckin having already had laparoscopic surgery for endometriosis 5 years prior, with a different surgeon. My symptoms and pain had returned, making my life truly challenging and my menstrual cycle unbearable. Dr. Seckin was quick to validate my…

  • Anita Schillhorn

    I came to Dr. Seckin after years of dealing with endometriosis and doctors who didn't fully understand the disease. He quickly ascertained what needed to be done, laid out the options along with his recommendation and gave me the time to make the right decision for me. My surgery went without a hitch and I'm healing very well. He and…

  • Nicholette Sadé

    Dr. Seckin brought me back to life! I am now 3 weeks into my recovery after my laparoscopy surgery, and I feel like a new and improved woman! Being diagnosed with Endometriosis, then 25yrs old in 2015, and discovering the severity of my case being stage 4, made me devastated. Dr. Seckin's vast knowledge of the disease, sincere empathy, and…

  • Jason Curry

    My wife had her laparoscopic excision surgery to remove endometriosis with Dr. Seckin on Jan 30, 2014. She doesn't write online reviews so I'm writing this on her behalf. I accompanied her with each office visit she had. The staff--Lucy and Kim, are very friendly, warm and professional. Dr. Seckin was excellent in every capacity. He spent a lot of…

  • Liz Filippelli

    He is an awesome doctor who saved my daughters life from debilitating endometriosis..she knew instantly upon awaking from surgery that she was better..that wad May and no complaints only praises for Dr. Wonderful Seckin!!

  • Karen N

    I was diagnosed with Endometriosis at 19. I saw several Endometriosis "Specialists" since then, had a few laproscopic surgeries to "remove" the endometriosis and continued to be in pain. I had a hysterectomy in 2012 and was told this would stop the pain once and for all. No such luck! Tired of spending days in bed with a heating pad,…

  • Lauren Rodriguez

    I researched and found Dr. Seckin after dealing with years of doctors who couldn't help me or refused to go the extra mile for their patients. I have to say I am truly blessed to have found such a compassionate and talented doctor. He is exquisite with everything he does, and both his team at the office and surgical team…

  • Kellya Vespa

    Dr. Seckin is a very skilled surgeon. There are not many doctors like him that truly understand the effects of endometriosis. I am lucky to have found him. The staff is wonderful too.

  • Meg Connolly

    Dr. Seckin truly LOVES what he does and cares about his patients from the bottom of his heart. My life has already changed in 3 weeks and I couldn’t be more grateful. Should I ever need another operation for endometriosis, Dr. Seckin will be the one to do it. I recommend him to anyone I come across with similar problems…

  • Elisandra O

    Dr. Seckin is an amazing Doctor he is very compassionate, caring and he will be honest with you. He's been my doctor for 19yrs and I am so grateful to have someone taking care of me that knows what he is doing and knows the best way to treat each and every situation. I would definitely recommend him and his…