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Single site ovarian suspension (SSOS), Seckin® technique, for endometriosis surgery of pelvic sidewalls and retroperitoneum

April 24-26, 2014
Video presentation:
Annual Congress Middle East Society and International Society for
Gynecological Endoscopy
Dubai, United Arab Emirates

 

Tamer Seckin1, Sultan Ozkan2, Ali Akdemir2, Serin Seckin3
1 Hofstra University Medical School, Lenox Hill Hospital, New York, NY, USA
2 Ege University Medical Faculty, Departmant of Obstetrics and Gynecology, Izmir, Turkey
3 Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

Objective:

To describe a new laparoscopic technique using GraNee® (R-Med, Inc) open loop grasper needle to achieve temporary single site ovarian suspension (SSOS), Seckin® technique, during endometriosis (excision?) surgery.

Material-Method:

After the pneumoperitoneum is established, a monofilament (70 cm 2/0 poliglecaprone 25) suture is introduced by a GraNee® (R-Med, Inc) open loop grasper needle. The suture end at the GraNee® needle tip is directed through the lower quadrant into the peritoneal cavity. Needle puncture is performed under laparoscopic vision after transillumination of abdominal wall to avoid vessel injury. Then, the needle is guided to pierce through the ovary and the suture end is released from the needle grasper. After the GraNee® needle is pulled out of the ovary, the suture end, which is already through the ovary, is re-captured by the GraNee® needle grasper and pulled out of the peritoneal cavity at the very point of entrance without any need for reinsertion. The suture, suspending the ovary out of the pelvic cavity, is temporarily secured with a Kelly clamp above the skin and subsequently tied over a 4 x 4 cm gauze {at the end of the case forming a profile of a sandglass} – CLARIFY MORE. Ovarian suspension facilitates excellent exposure and clear visualization to proceed with the precise excision of peritoneal and retroperitoneal endometriosis. The sutures are pulled through and ovaries are released 12-18 hours postoperatively to minimize adhesions.

Results:

This technique using GraNee® (R-Med, Inc) open loop grasper needle for temporary ovarian suspension is reported for the first time. It has been used effectively over a decade in pelvic sidewall endometriosis surgery. Single site insertion of the needle and simultaneous puncture through the ovary, firstly, allows a well controlled, safe, speedy, and practical procedure without the need for two puncture sites, which would increase the chance of an abdominal wall hematoma. Secondly, it also avoids the necessity to grasp curved or straight needles in the needle holder in order to pierce through the ovary. I rephrased this- is it accurate?

Conclusion:

This simple technique, which is safe, easy, and practical provides retraction of the ovaries and tubes during complex endometriosis surgery involving pelvic sidewalls and ureters. The feasibility of this method should be considered among other suspension techniques. Our choice has been to use single site ovarian suspension (SSOS), Seckin® technique exclusively in all patients who require ovarian and peritoneal excision of all endometriosis stages.


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