International Medical Conference Endometriosis 2025:
Endometriosis 2025: Your Mother Should Know, Your Doctor Should Know Better!
Progressive, Regressive, or Persistent Endometriosis/Multiorgan Surgery Including Thoracic Endometriosis - Tamer Seckin, MD
Our next speaker doesn't need much of an introduction. He is our founder and president of the Endometriosis Foundation of America, the surgeon here at Lenox Hill Hospital and a world-renowned gynecologic surgeon who has specialized in excisional techniques for endometriosis surgery. Tamara, thank you. Thank you.
Good morning everyone. It's nice to see you here. I really get excited to have these events every year. Harry is talking about the past. Maybe you don't know my past, but I should tell you a little just very shortly. I am from Ankara Turkey originally and came here in 1980. After two years of residency there, I couldn't get into a program because I was from another planet, so I snuck into a general surgery house staff position, but it's a paid position. It was very interesting coincidence where I was trained in Turkey on Kara. We were trained very well. We did one year of, before finishing medical school, we did externship internship one year and then I did two years of OB GYN residency, one of the best places in Middle East, probably lots of cancer surgery. Incredible. But I did work in burn unit. That burn unit work almost couple months has really affected me as a young intern, how I learned how wound never heals, how infected wounds kill people, electrical burns.
And then I was lucky when I came to Buffalo, that's how I met excision. I was in the world most prestigious breast cancer spot in Roswell Park Memorial, working with these guys, no, Moto and Rosetta. It was all about excision for lesions that they could not see on ma mag. It's a very pinpoint lesion. They would remove them with border free excision. That was the word. And then obviously it wasn't easy, difficult to catch up to make it short, came to New York and in 1985, and since then I'm practicing here professionally in this hospital almost 30 years.
I did pick this subject, multiorgan, which I usually talk, but we can't cover everything. But I'm going to give you a perspective of two extreme rare but most extreme cases, spectrum that we could really face before I it to be basically, I want you to take a notice of this Luba luko, a cartoon that was done for our foundation for a special gift to me, a woman trapped in her uterus. There's so much truth in this picture. Luba is a very well respected cartoonist in New York Times and in history, there's 200, there's a new book that came, a bestseller, New York Times, Kat Bohanan from California. She did five years of PhD. It's an incredible book. Please buy if you don't, I'll buy you one. Everything. Every organ we developed was out of necessity and our uterus were also developed out of necessity, our instinct, survival of mammalians to be immortal.
Kind of right now we live almost 80 years and women live more than men maybe, but uterus also developed out of necessity and uterus. Job was to have not to have periods to have a baby and uterine muscles were programmed to pump that eight to nine pound baby between the legs. I mean that's an incredible job. It's not like heart that pumps blood every six times 60 times a minute. This is an interesting evolutionary picture from 13,000 years ago from Gobekli in Turkey. This is 6,000 years before this woman, most likely breached delivery, probably lost her life and somebody who loves her just made it sure that we see it today. 13,000 years later, drama is always so a man died at war. Women died because they were women and evolution, biological evolution basically stopped those women who couldn't have children today, they get divorced in Middle East.
If you don't, they don't have children. They just let go and get another one. It's the same mentality, so we don't have time to get all of it. But obviously with today's team, mothers should know. Your mother should know, and we doctors should know even better applies in certain part of this disease, which is very dear to me. The peritoneal disease, the enigma, the unknown, the mystery about endometriosis is at the peritoneal level. This is where people, why we delay 10 years of recognition. This is why the symptoms are nonspecific because it is is peritoneum. On the other hand, I'm going to touch sciatic and distant thoracic portion because it represents the other spectrum of endometriosis. So for researchers, I intentionally picked this. Dr. Ahan graciously just forwarded me last night this, I didn't know about this, but to very much parallel to our presentation, NIH just came out with recent guideline, A positive history of first degree relative increases the likelihood of development endometrial.
Thank you. I think that's very important. It also says do not exclude the possibility of endometriosis is transvaginal. Ultrasound scan is normal and history is suggestive. Thank you again. NIH is doing good work. I appreciate that. So we know we have a disease that's also a condition. Dr. Martin and many others that we talk about. This endometriosis is more prevalent than we know and as a condition, but as a disease there has to be fibrosis. And why this angiogenesis develops into this fibrosis, we really don't know. That is the big challenge and frontier right now, but we know it's about wound healing. Every wound heals in the end. After six weeks to six months, there's a contraction. There's fibrotic element continues to process in that wound and there is truth in end materials about that too. At peritoneal level. I'm showing you that picture. I'm going to show you many pictures like that.
So I'm going to go a little bit fast. It's a pan peritoneal disease. It's all over peritoneum. That really represents the challenge we have. I hate people who use extra pelvic endometriosis. So why is this disease from birth bleeding becomes very aggressive, blocking kidneys, people getting wrong procedures like nails in their sacroiliac joints coming with stage five endometriosis with why does this happen? This is why we are here today. So that's why I'm going to focus on peritoneal endometriosis. Every lesion representing pain is a microcir of like a microcir to the brain. So I intend to remove every lesion separately. That's why I encourage or please consider using not exclusively use superficial end image, but you can use superficial, maybe peritoneal, but more importantly peritoneal endometriosis because I think the word superficial makes the woman's disease superficial. And endometriosis is not a superficial disease. I exclusively use alu contrast technique. I started, I patented this because I think it was very important for, I don't want the company steal this idea because after so many years of looking for small lesions, I figured out that under blue contrast you kind of more lesions and more pathology, which is not recognized by nobody. I've been presenting this. Some people are approaching before this. But overall, you see incredible precise lesions with this. I don't know, could you turn the lights off please?
The contrast created retroperitoneal basically blocks the red and yellow hues reflecting through the peritoneum. So you see lesions more specific and more precise, which is not only with its pigmented color but also with its fibrosis white color. And I'm going to go more into this. We have in last 12 years, maybe 14 years, I have, this is from my associates that works with me. This is not they really, this is our true numbers. I have excised 34,000 specimen in the last 14 years. That's before that. I could go up to probably go, but the reason I'm saying this is many of these specimens were all, this is all peritoneal excluding dyes and other deep endometriosis cases. And many of the time theses in these collected specimens, the lesions were on the left side. So with the help of my associate, Dr. Hakan and Isha, we have more precise, very clean data.
Now for the last approximately seven years now, 600 patients, we have almost 9,000 specimens. 61, 10% is eliminated with they were negative. And at these specimens, 37% of the time patients were first time surgery. The others were reve surgery, 8% my reoperation rate, I thought it was more than little 10, but this is what they came out to be. And we operated 35% of the population were reve surgery by others. What this really shows that more lesions around the patient's left side more prominently on the left side, this is important because if you look any book, oh, peritoneal is more at the cul-de-sac or ute. It's not. It's on the left. Zone three, we zone these. I could go into these, but there's more detailed portions of these zones. But this is important I think for time-wise, I have to move on fast. There are more detailed numbers of this where in these three cases more inflammation and fibrosis also pops out are retrieval of positive endo lesions about 50%, but the rest are all inflammation and fibrosis up to 75%.
So I want to just focus on adolescent endometriosis to make sure that you understand the uterine discman area pain, how it becomes later adding up to peritoneal component becomes chronic pelvic pain. But this is the critical ear we really have to focus. I could talk about this for ours, but most importantly, the most important organ really gets hurt with endo as much more than pelvis. It's probably brain, your psyche or mine. And this is something very important in my practice. It is my suggestive protocol for patients who see psychiatrists or who are on significant medicine opioids or have other issues that I suspect they see a psychologist. And about 25% of my patients see psychologists. And it's very important to gain patients trust and also maintain your transparency.
So very quickly, I'm not going to go into endometrioma, Dr. Balloon is going to get into this, but these are the beautiful pictures I want to share with you quickly. The birth of endo, it is bleeding and the way it causes fibrosis, and this camera is under blue water. I'm right now three four millimeters away from the lesion. And it's important to note that these lesions, even small lesions, bleed and format at fibrosis, but underwater, these are like grape leaves you want to grab and eat. But the thing is, the reason I'm presenting this, these are the great source for probably future research. It's like you could do micro biopsies from these lesions like you do amniocentesis, right? So what happens in the earliest phase of these lesions? Look at this earliest phase of lesions that is different when the aggressive portion of the disease pops up. I'm sure we'll get a lot of detective like clues here. That's why we are here together. Scientists, you see magnificent presentation. I get really excited even though 60% I don't understand, but at least there's a click in me that I will do it better later. So I want you to see the difference with the blue dye, how much difference it makes. Look at this.
You are noticing some holes there, right? Those holes are very serious. I think it has a significant effect of disease became persistent or progress. These holes are like potholes, like you put a flower and it grows in probably imagine retrograde bleeding, pulling in those holes. And also there are others also also claim those holes be the origin of pain. So I whoops, want to, yeah, I mean this is where you want to do amniocentesis. Look at that. Vessels ready to explode. And this is another picture I love to share with you guys. These holes are rare, real. And I think this is the hole that really sets a lot of problem in peritoneal pathology other than the lesion because it brings a lot of, I think this is the same holes that cause central tendon to perforate in the future. The reason I say very confidently, and I believe in this is because oh, Harry was going to talk about future of surgery.
I mean Harry May not know about AI much. I use ai but I don't know. But this is what we are trying to do. I think if Elon Musk got into White House, let me tell you that robot, what we use as intuitive will have more meaningful, more powerful way of getting into our lives. It's not going to be us robot also going to threaten us too. I guarantee you this is an AI model we are trying to develop with one of my engineers, what you saw as pathology, we are trying to have an active tracking like anybody uses drone in drones, there's active tracking, but this is active tracking with multiple cameras. In other words, multiple lesions will be spotted. So we don't lose lesions when you start the surgery, surgery is a long process. Your eyes get tired and it is very challenging. So this two extreme other part than peritoneum, thoracic and sciatic is something I want to present because lately I've been doing these cases, I get excited to be honest with this.
Everything else is so simple. And if you know anatomy really thoracic, both surgery is simple. For me, the most difficult surgery is truthfully is endometrioma to leave a healthy ovary back when the patient expects kids, they're old, they plan so much. These are good surgeons will have incredible results with this radical things people think it's impossible to do at this point. I do acknowledge our honoree. Celine has been written about this. Both sides, both pulmonary and the other sciatic portion. It's so beautifully written. He's a wonderful writer and scholar that I follow very well. So in the past I used to do these sciatic with finger guided and I look at myself and left, this is like 10 years old, but we had quite a few of these and they did well. But I didn't know how to approach even I had vascular surgery background.
I never thought we could approach Duwe Tanner and Dr. Roman is here. You see here, there he is. Beautiful writing. And I must say I benefit a lot from your writings to get encouraged to study. I want to do this before, but in New York it's not easy to do neurosurgery for malpractice purposes, but this is what you start. So I mean I was here but I didn't realize how close I was to real guys and boys there. So it was interesting. Anyways, we did, we did, what am I here? Let's see where I am. So this is a patient we just did, we did neuro navigation. My friends in Turkey later I figured out they have done tons of it, at least 10 and they published it. So it's one of those cases. 36-year-old had three surgeries, bowel resection along with hysterectomy. But the patient comes in with serious sciatic symptoms with almost 1.5 cm mass on the sciatic. We put these subcutaneous needle electrodes. Thank God people knows what they were. I didn't know about this also, but I learned. So this is how it really looked inside. But you see on the right side there is little dimple there. It's like the tip of the iceberg.
That's why these isolated, the problems in those areas may be missed by many, many doctors. It's not easy to, unless you really look for them. So this is basically, this is not going the way I want it, but okay, let's see. Anyway, so basically you start medially pushing the big vessels and identify the gentle femoral nerve. And then we proceed with, I'm not sure why this is doing this, but let's see. Anyways, is it? That's okay. Alright, let's see. Alright, anyways, this was a neuro navigate. The bottom line is I was asking the navigator which nerves I'm in. I knew where I was, but he was telling me exactly it was S one, S two, S3. It's very impressive. We removed these two masses there along with large lympho specimen.
And this is the most prominent part of the procedure. The endo is at the lumen of the artery or way in here. I didn't ask her, but she said she's never seen it. I've never seen it. This is the lumen. I think I like to share that with you. So these are the beautiful writings from our friends, which I wanted to talk about. T and Roman is here. People ask me, how did you get Dr. Roman here? I said, he's my friend. He's such a famous guy. Yeah, he is. It's true. He's done so much. I want to show, I'm not going to go to the die matic and though, but this is the tis fascia right above adrenal gland. You really have to lift the liver up guys. It goes up there. Hold on, I'm done.
Sunway asked me to show my trip. So guys, surgery, wait, living in New York and stress so much people, my residents remember kin is crazy. I am not crazy, but I am reasonable. I had a nice crew of four guys who were experienced. I always dreamt of sailing, not sailing offshore from the beach. That kind of, I mean this is a serious thing. So this is me swimming. I'm not swimming vegetarian or Hamptons or Florida. This is somewhere very unique and there are fishes around me. It's very lonely out there. Guess where I am? I'm in the middle of Atlantic Ocean.
So when I talk here, please take me seriously. I mean business. Okay, so depth is 6,500 and this is what we did. So it took 17 days, eight hours, and in the middle I swam. We swam in that ocean. This is whoops. So this is me swimming. I mean we had a bottle of champagne before that. But then it was really interesting because of you really feel it's a solitude that you can never have 17 days. You see sunset, sunrise. I have different pictures I think, but so you think about a lot of things you did in life, but it is, you connect the horizon, every pixel in the horizon and you become one with them. And the sky is incredibly beautiful. No other lights. I think I was lucky and I just want to share with you. Thank you, Sonya. I wasn't going to present it because it was a little bit so personal, but thank you. This is the other reason I also here my grandchildren. Appreciate for the time. Thank you so much.
