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.
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.
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.
- 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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