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Our Techniques

by drseckin.com | Posted on June 10, 2020

by Tamer Seckin, MD Endometriosis Excision Surgeon / Seckin Endometriosis Center (SEC)

Our Endometriosis Techniques

Our endometriosis specialists work with patients to understand symptoms, diagnosis, and treatment options for endometriosis.

Introduction

Anatomical Preservation & Resoration

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.

A uterus shown on a monitor during <a href=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.

 

intramural <a href=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.

Conservative Surgery

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.

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.

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). 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.

 

intramural <a href=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 <a href=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.

"Cold" Excision

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.

Pathology

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.

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.

Robotic-Free 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.

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

 

Integrated Approach

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.

Ready for a Consultation?

Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.

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.


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