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

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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    I have struggled with endometriosis and adenomyosis since first starting my period at 13. I was diagnosed at 21 and what followed was a series of unsuccessful surgeries and treatments. My case was very aggressive and involved my urinary tract system and my intestines. After exhausting all of my local doctors I was lucky enough to find Dr. Seckin. We…

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    Like so many women who have tirelessly sought a correct diagnosis and proper, thorough medical treatment for endometriosis, I found myself 26 years into this unwanted journey without clear answers or help from four previous gynecological doctors and two emergency laparoscopic surgeries. I desperately wanted to avoid the ER again; a CT scan for appendicitis also revealed a likely endometrioma…

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    Dr. Seckin literally gave my wife her life back. I am eternally grateful to him for his generous, determined spirit to see that Melanie finally live free from the prison bonds of Endometriosis.

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    I am so grateful to Dr Seckin and Dr. Goldstein. My experience was nothing short of amazing. I was misdiagnosed with the location of my fibroids and have had a history of endometriosis. Dr. Seckin was the one who accurately diagnosed me. Dr Seckin and Dr. Goldstein really care about their patients and it shows. They listened to my concerns,…

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    When I think of Dr. Seckin these are the words that come to mind. Gratitude, grateful, life-changing, a heart of gold. I feel compelled to give you a bit of background so you can understand the significance of this surgery for me. I am passionate about Endometriosis because it has affected me most of my life and I have a…

  • Jaclyn Harte

    Dr. Seckin and Dr. Goldstein radically changed my quality of life. They treat their patients with dignity & respect that I've personally never seen in the literally 25+ doctors I've seen for endometriosis. This summer, I had a surgery with Dr. Seckin & Goldstein. It was my first with them, but my 5th endo surgery. I couldn't believe the difference,…

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    I was in pain for 2 years. I was getting no answers, and because dr Goldstein and dr seckins were willing to see and treat me I'm finally feeling almost back to normal. They were very down to earth and helpful in my time of need. Dr Goldstein was easy to talk to and caring, she took care of me…

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    Dr. Seckin is one of the best endometriosis surgeon. Every time I go to the office, he really listens to me and is always concerned about my issues. Dr Seckin's office staff are a delight and they always work with me. I feel I can leave everything to them and they will take care of it. Thank you to the…

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    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…

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    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…

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    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…

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    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…