Endometriosis is characterized by its capacity to alter the normal anatomy of organs through severe scarring, ultimately causing organ dysfunction. Scarring causes organs to fuse together, compromising their motility and autonomous functioning. Consequently, organ dysfunction allows endometriosis to infiltrate organs and organ systems. Using sophisticated visualization and imaging technology, Dr. Seckin examines individual lesions, excising endometriosis on a “per-lesion” basis. This allows for meticulous repair of the tissue, resulting in restoration of normal anatomical functioning. After excising lesions, laparoscopic suturing is utilized to repair tissue and reconstruct organs.
Multiple Organ Excision
Endometriosis is classified as a multiple-organ disease. It involves non-reproductive organs in addition to organs of the reproductive system, such as the bowels, bladder, diaphragm, kidneys, and, in rare cases, the lungs. This necessitates a multi-disciplinary surgical approach in order to address lesions that have spread beyond the reproductive organs. Bowel endometriosis, for example, is particularly complex and requires a multidisciplinary surgical team in order to provide comprehensive treatment. During this type of surgery, Dr. Seckin works with a team of highly skilled colorectal and urology specialists in order to minimize postoperative complications and increase the likelihood of a successful outcome.
There are two surgical approaches to endometriosis: conservative and definitive surgery. In conservative surgery, organs such as the ovaries, ureters, and bowel are preserved. Despite the preservation of these organs, conservative surgery is not superficial surgery; conservative surgery entails the thorough excision of endometriosis lesions without the need for organ removal for successful treatment. Conservative surgery is performed for all patients with well-recognized endometriosis lesions, fibrotic lesions, and acute regions of inflammation. In certain cases of deep infiltrating endometriosis and adenomyosis where nerve involvement and corresponding symptoms of neuropathy is likely, we resort to definitive surgical treatment. In definitive surgery, what is defined as conservative is complemented with the removal of organs. A hysterectomy, which is a definitive means of treatment for diffuse adenomyosis, is an example of definitive surgery. Removal of the ovaries (oophorectomy), bowels, part of the bladder, and reimplantation of the ureter, are all a part of definitive endometriosis surgery.
Known as "the gold standard” for endometriosis surgery, laparoscopic deep-excision surgery combines the standard surgical GYN imaging technique of laparoscopy with excision, a technique derived from the surgical removal of cancer (particularly breast cancer). Excision surgery is our preferred method for removing endometriosis lesions as it is the only technique that removes the lesion in its entirety. Methods of fulguration and laser ablation are only capable of removing lesions superficially. In other words, endometriosis tissue that lies beneath the surface of healthy tissue is oftentimes left behind–effectively increasing the likelihood of symptom recurrence. Deep excision surgery preserves the borders of healthy tissue surrounding the lesion, while methods of fulguration and laser ablation present a risk of damaging surrounding tissue.
Minimally Invasive Surgery
We ensure all patients that our surgeries, even ones as complex as bowel endometriosis excision surgery, are performed using the minimally invasive laparoscopic technique. In embracing minimally invasive laparoscopic surgery for all cases of endometriosis, we look to give our patients their best chance of symptom relief, recovery, and nearly-scarless results.
Another unique aspect of our excision surgery procedure is our use of Aqua Blue Contrast (ABC). We patented this technique specifically for endometriosis patients. During surgery, we make a small incision into the peritoneum (lining of the abdominal cavity), a common site for endometriosis to reside. We then fill this site with the ABC solution. The solution enhances the visibility of lesions that are difficult to see due to the intense brightness of the laparoscope light source. We often compare our use of contrast to that of stars in the sky. During the day these stars are not seen, even though they are still present. However, when the sun’s light disappears in the night, the stars are revealed. Similarly, our contrast does the same to eliminate laparoscopic glare, allowing the surgeon to discern endometriosis lesions otherwise not visible to the naked eye. Because of this, endometriosis that would go undetected during normal laparoscopic surgery can be identified and removed allowing our patients to see drastic results with symptom relief and lowering the chances of further endometriosis development.
Techniques of laser ablation and fulguration often rely on heat and electricity to destroy lesions. These often unnecessarily powerful energy sources are associated with damaging effects on surrounding healthy tissue, and only remove lesions superficially. For these reasons, we exclusively use the “cold excision” technique, which excises the endometriosis lesions using minimal to no electricity, and best preserves the body’s healthy tissue.
With our method of cold excision surgery, we are able to preserve removed lesions and send them to a pathology lab, where they are tested for endometriosis at the cellular level. We feel this is a crucial component to our surgeries as it is the best way to definitively and formally diagnose endometriosis. It also helps us to better understand the possibility of lesions growing or spreading. With other surgical methods such as ablation, the endometriosis tissue cannot be tested because it is often destroyed during surgery.
We are committed exclusively to the deep excision of endometriosis using advanced laparoscopic techniques. We have serious reservations concerning robotic surgery, particularly for cases of endometriosis, due to its present lack of haptic feedback and proprioception, and limited capability for handling advanced cases involving the retroperitoneum. Although our surgeons are trained in robotics, we do not use robots as the machines are not precise enough for meticulous endometriosis surgery. Robotic surgery also requires more incision sites, leading to a more invasive procedure with more scarring than minimally invasive laparoscopic surgery.
Diet and lifestyle changes can be used as a complementary measure in the treatment of endometriosis, particularly for pre- and post-surgery patients. Because endometriosis causes widespread inflammation which manifests in symptoms such as constipation, diarrhea, and abnormal gas and bloating, patients may experience some symptom relief when following certain anti-inflammatory diets. In addition to dietary suggestions, we may complement surgical treatment with restorative pelvic floor therapy, osteopathic approaches to pain management, including hormone therapy, and alternative therapies such as acupuncture and herbal medicine.
Our office is located on 872 Fifth Avenue New York, NY 10065. You may call us at (646) 960-3080 or have your case reviewed by clicking here.
I am a physician who suffered from deep infiltrative endometriosis. I needed laparoscopic surgery, so I went to see my former gynaecologist and he performed the procedure (a surgery which he supposedly does hundreds of times a year) last November. I had severe pain again when I had my period in January and was advised to go on taking a…
After years of excessively painful periods, a serious loss of quality of life, and a series of uninformed and uninterested doctors, Dr. Seckin and Dr. Goldstein turned my life around. I was told I woke up from my surgery almost a year ago with a smile on my face, and I haven't stopped since. Before I heard of Dr. Seckin,…
Dr Seckin and his team gave me back my life! Tomorrow will be 1 month since my surgery and I feel great. Dr. Seckin, Dr Liu, and Dr Goldstein are not only beyond words talented and amazing Doctors, but they are also genuinely wonderful and caring people. I cannot say enough great things about Holly, Asiye and Kim as well.…
Dr. Seckin and his staff spared me from years and years of heavy periods and unbearable endometriosis pain. After having surgery with him (my first) I can now function like a regular human. No more eating NSAIDs like candy and calling out sick from work. Thank you, Dr. Seckin!
I underwent surgery with Dr. Seckin in 2017 and have felt like a new woman ever since. If you have, or suspect you have endometriosis, Dr. Seckin and his compassionate team of surgeons and staff are a must-see.