Our Techniques

Minimally invasive excision surgery for endometriosis

For thirty years and counting, Seckin Endometriosis Center has performed thousands of laparoscopic surgeries for endometriosis and other gynecological conditions such as fibroids, adenomyosis, and adhesions. We have mastered the art of minimally invasive endometriosis excision surgery thanks to our intricate techniques and patented instruments. Our world-renowned center is steeped in expertise with laparoscopic deep-excision surgery, which removes all suspected endometriosis lesions throughout the body, ranging from disease in the ovaries (endometrioma), the lining of the abdomen (peritoneum endometriosis) and  bowels (bowel endometriosis). Below are just a few key ways in which our award-winning surgeon can help relieve your symptoms and restore you to good health.

Meticulous restoration of anatomy with reconstruction and repair

Endometriosis is characterized by its alteration of the normal anatomy and severe scarring of organs, causing organ dysfunction. Because of this scarring, organs can fuse together and not function independently as their motility becomes compromised. This organ disfiguration, in turn, allows for endometriosis to invade the organ. Because the disease can affect multiple organs, mainly non-reproductive organs such as the bowels, ureters and nerves, the most common complaint is pain. Therefore surgery must be done in the most meticulous way. Your Seckin Endometriosis Center surgeon will look to examine every single lesion visualized via laparoscopy, on a large operating room monitor. This highly pixelated image allows Seckin Endometriosis Center surgeons to operate at a level of utmost precision.

A uterus shown on a monitor during laparoscopic surgery
The HD-4K camera with video monitor used during our laparoscopic deep-excision surgery technique. A) The basic set-up for one of our two monitors. B) A uterus shown on a monitor during laparoscopic surgery.

Our Seckin Endometriosis Center surgeons are experienced in both operating on multiple organs and properly excising endometriosis from wherever it may infiltrate while abiding by three major principles: restoration of the anatomy, reconstruction and repair. The goal is always a conservative means of treatment, and the preservation of organ function. 

Many surgeons are unable or unwilling to remove suspected endometriosis tissue from a variety of organs — not our Seckin Endometriosis Center surgeons. Our practice prides itself on our well-honed ability to suture tissue and reconstruct organs after removing suspected endometriosis lesions. Suturing skill under the guidance of a laparoscopic camera is arguably the most challenging aspect of endometriosis surgery and the hallmark of a skilled endometriosis surgeon. Without this skill, proper endometriosis surgery will not be accomplished. This is why we have taken the time and practice to master this technique, ensuring our patients' best shot at recovery with minimal complications.

intramural fibroids, seamlessly suturing
Reconstructing the uterus is required in any procedure that cuts into the uterus, such as certain cases of adenomyosis and intramural fibroids. By seamlessly suturing the uterine wall and the tissues of other organs we operate on, we are able to conserve organ function.

Laparoscopic deep-excision 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.

During laparoscopy, we make three to four incisions (about five millimeters each) into the abdomen. These small instruments allow us to make minor incisions, ensuring that there are nearly scarless results and we accomplish our goal of providing the most minimally invasive surgery possible.

An incision is made through the navel for the introduction of a laparoscope, a long thin tube with a light and camera attached to it. This allows us to examine the pelvic and abdominal cavity on high-quality video monitors. 

Laparoscopy entails visualization of the abdomen and pelvic cavity through an instrument known as the laparoscope
During laparoscopy, three incisions are made into the abdomen and pelvic region. A tube is inserted into the first incision site in order to fill the abdomen with gas, creating open space to operate. A laparoscope, which has a light and camera attached to its tip, is then inserted into the second hole. Finally, a grasper can be placed into the third incision site. 

The goal of excision surgery is to remove all diseased tissue in its entirety. Using a laparoscope for visualization, our surgeons can navigate the abdomen and pelvic cavity and then cut out suspected endometriosis lesions using cold excision scissors. This laparoscopic "deep excision" technique makes our surgical procedure very unique in two major ways. 

"Deep-excision" and endometriosis lesions

Unlike fulguration and laser ablation, deep-excision surgery removes each suspected endometriosis lesion in its entirety. Picture an iceberg. While an iceberg appears to loom large above water, the majority of the solid lies below the surface. An endometriosis lesion can be thought of in the same way. Inexperienced surgeons perform techniques that will remove the "tip of the iceberg" of the disease, but leave the endometriosis lying underneath very much intact. This will cause persistent symptoms, infection to surrounding tissue and even further disease progression. That is why we stress the importance of “deep-excision” surgery, which means removing the lesion fully, including below the surface. We feel that this is the only way to truly guarantee the removal of each lesion, thus giving patients their best chance of symptom relief and further spreading of the disease.

“Cold Excision” and pathology reports

We here at Seckin Endometriosis Center abide by a strict “cold excision” technique whenever we remove specific endometriosis lesions. We favor the method because excision surgery wholly excises endometriosis lesions — but that's not the only benefit. It also leaves the lesions intact, allowing for collection and further examination by pathologists. (The only real way to formally diagnose endometriosis and the severity of it is through a pathology report.) Many other surgeons use techniques such as fulguration and laser ablation, which use electricity and heat to destroy the endometriosis. This, we believe, is a flawed method for several reasons. Not only is healthy tissue harmed, but endometriosis lesions aren't entirely removed, and are destroyed which prevents pathology from collecting the specimens and issuing a pathology report. We feel that every endometriosis patient deserves to have an extensive surgical case review, and a large component of this is a pathology report. 

intramural fibroids, seamlessly suturing
Proper “cold excision” uses minimal to no electricity or heat in removing endometriosis lesions. This preserves surrounding healthy tissue and ensures a specimen is obtained for pathology. This cannot be done in laser ablation or fulguration techniques.

Aqua Blue Contrast (ABC) technique

Dr. Seckin’s patented ABC contrast allows us to easily see endometriosis scar tissue during laparoscopic deep-excision surgery
The Aqua Blue Contrast (ABC) technique is Seckin Endometriosis Centers' patented surgical method for identifying all endometriosis lesions that would be otherwise invisible to the naked eye.

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.

No organ overlooked

Reproductive or not, endometriosis can affect a variety of organs and surgery for the disease is often a multi-specialty surgical event. As is often the case with Seckin Endometriosis Center's surgical patients, urologists, gastrointestinal specialists, and others, are all working together under the direction of the primary endometriosis surgeon, Dr. Tamer Seckin. Together, all specialists not only operate on specific organs but reconstruct them. 

Conservative surgery

Suspected endometriosis lesion
Suspected endometriosis lesion sites after the tissue have been removed and bordering tissues are disease-free, using ABC contrast in excision surgery.

There are two surgical approaches to endometriosis: conservative and definitive surgery. We operate with a conservative surgery mindset first. In conservative surgery, organs, such as the ovaries, ureters, and bowel are not removed. Despite the preservation of these organs, the procedure is by no means a superficial surgery, as our Seckin Endometriosis Center surgeons make sure no endometriosis lesions are left behind. Conservative surgery is performed for all patients with well-recognized endometriosis lesions, fibrotic lesions and inflammatory locations where all abnormal peritoneum tissue is removed to provide patients with their highest chance of relief from symptoms. 

Definitive surgery

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 a 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. While we always resort to conservative surgery, patients with adenomyosis (endometriosis within the uterus) and deeply infiltrating endometriosis should be aware that because of the likelihood of nerve involvement and corresponding symptoms of neuropathy, a definitive form of treatment is often necessary. These definitive surgeries are often multiple organ surgeries and are lengthier than conservative surgeries.

No robotics

Robotic surgery is becoming a popular surgical option in the field of endometriosis. Although our surgeons are trained in robotics, we do not use robots as the machines are not precise enough for meticulous endometriosis surgery. The machines fall short of our high standards laparoscopic deep-excision surgical technique. Robots simply do not have the skill of our highly experienced surgeon’s hands, especially when coupled with customized equipment. Robotic surgery also makes more incisions, leading to a more invasive procedure, and more scarring than minimally invasive laparoscopic surgery.

Suspected endometriosis lesion
Robotic surgery requires more and larger incision sites (a minimum of five incisions) than a normal laparoscopic surgery (3-4 incisions).

For these reasons, we view robotics as “maximally invasive laparoscopic surgery.” In fact, of the hundreds of patients we operate on, a considerable percent are patients who have had robotic laparoscopic surgery in the past, only to have their symptoms recur. In other words, robotics may set a patient up for repeat surgeries. Here at the Seckin Endometriosis Center, we strive for your surgery with us to be your last, and we've found that by avoiding robotics, we can achieve the best, most permanent results.

Empathy

Whether it be a lengthy delay to diagnosis or having to endure multiple surgeries, oftentimes, endometriosis patients have been through the wringer, which is why we treat each and every one of our patients with a tremendous amount of empathy. Post-op we take great care to make sure our patients have a guide to full recovery. We may complement surgery with recommendations for a pelvic recovery protocol, which may include pelvic floor exercises, regular diet, and even pain management, with diminished use of narcotics. We believe in an open door policy between doctor and patient both pre and post surgery. 

Summary

What sets Seckin Endometriosis Center apart from other endometriosis surgical centers:

  • Meticulous reconstruction, repair, and restoration of every organ and its function that has been affected by endometriosis, thanks to our precise and meticulous tissue suturing ability.
  • Complete removal of each endometriosis lesion through “deep-excision.”
    Preservation of endometriosis specimens through “cold excision,” allowing for pathology to test each removed lesion.
  • Removal of all suspected endometriosis lesions that otherwise would be naked to the human eye, thanks to our patented Aqua Blue Contrast (ABC) technique.
  • No expense spared in high-quality imaging, ensuring the finest laparoscopy procedure.
  • An extensive medical staff on hand during your surgery
  • A conservative surgery approach to every case, in which we will provide patients with options, perform a thorough and meticulous excision surgery for endometriosis, and, finally, only perform definitive surgery techniques (such as a hysterectomy) in the rare instances when we see them being highly beneficial and have the patient’s consent and comfort.
  • A highly meticulous and sensitive surgery that would be incapable of accomplishing using robotics, due to our decades of expertise in the field.

Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at 646-960-3040 or have your case reviewed by clicking here.

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Patient Reviews

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  • Sheena Wright

    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.

  • Angela Aro

    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…

  • Emi O

    Seckin and Dr. Goldstein changed my life!

  • Kristin Sands

    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…

  • Wilfredo Reyes

    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.

  • Carla

    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,…

  • Melissa Boudreau

    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,…

  • Megan Rafael Moreno

    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…

  • Nancy Costa

    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…

  • 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…