International Medical Conference Endometriosis 2025:
Endometriosis 2025: Your Mother Should Know, Your Doctor Should Know Better!
Unintended Consequences of Endo Surgery - Tamer Seckin, MD
That's right. Thank you. There are people here. Unbelievable. I'll make it short guys. It's been a long two days. You're right. Nobody wants to talk about complic. Well, it's not easy to talk about complications. Well, I have to be. I'm going to be fast. So I'm not going to present all my slides I have, but I will confess to you, there hasn't been any complications that didn't happen in my life. I lived through them and I survived. And if you don't lose sleep, if it doesn't bother you, you can't do this job in my opinion. But you have to be extremely careful and we become the second victim that nobody talks about and there's not much people you can talk other than yourself and some friends you can call.
That was a great presentation. The reason I'm continuing to present my sciatic cases because I'm not in this atmosphere, we don't really jump to sciatic nerve much, but it's important to use very bloodless surgery and I'm afraid of cordes and stuff even. I really don't like quarters because I've seen terrible cases before and I'm very careful. In this case, we really use, it almost ended up being a very bloodless surgery. This sciatic case we did and I had a vascular surgeon, I had all things backed up me because I don't do as much as sciatic surgery that you see Dr. Roman does. Sinai has done because they live in a different world than we do. But overall, this patient, this patient really walked out from hospital, came crippled on a crunch and incredible. And she had hysterectomy at very prominent place before he had bowel resection before and we removed two masses as a shared with you.
She had intravascular invasion of the nodules Also, I have to tell you, I did go over Dr. Roman's beautiful step-by-step video too before I do this because we don't do this often. But it wasn't that difficult at all. We just moved on. The case was done within two hours or so. Anyways. So you see some heroes here. They're big egos. We are very prominent people. But I have to tell you, these well-known surgeon to you, some of their professional lives have really been crippled with complications and they live with it. And I know them firsthand. There's nobody that did not have complications. So complications really tests you not only as a surgeon, also as a person. And despite all the things that we have advanced complications right around the world, that doesn't change much. And fistula has been steady and one of the thing is us end neurosurgeons, there's fatigue.
There is less help in the OR and also overconfidence, I have to say. And the nature of the disease. Technology is an instrument. We jump in and we do things, but most of it you have to understand endo tissue is, I like the word Dr. Lina used. He said he used anatomical complication. The tissue is anatomically complicated. It's oxygen deprived, compromised less tissue integrity, bad tissue. This is not your friend this tissue. So you'll have a problem on intraoperative complications. I don't call it complications. They take care of the except vascular ones. But the post-op complications, I assure they're all unrecognized injury during the case. Don't fool yourself. There's something you didn't see or the tissue traps you. There are blebs, there are crips in the bowel mucosa that you may cut. Even safety exam may assure you falsely. There you go. You come from, this is one of those patients. We were so good. We did test everything. I stitched it the way I stitch all the time hundreds of times. And then she comes a week later like this, you scratch your head and it only takes, she gets an ileostomy. It only takes six months later. We just did this fistula repair last week, four days ago, five days ago. So basically mobilize the tissues very well for attention free closure.
I said I'm going to be fast, but I have to be fast. So basically we identified cervix, vagina, fistula tract. We basically mobilized it completely for attention free and we close it in two layers. I'm not going to go through this. We've got to move. So the patient will do well. And I have many fistulas I have repaired. I don't really sit on it many times. Rec, vaginal fistulas can even it's a pinhole defect may close. You got to be patient and don't jump urological things. It's also your bladder and uter. Vaginal fistulas are very forgiving too. You put a stent, they heal. So this is a case that is rare. This patient came from Johns Hopkins. I'm going to tell you she had multiple toric colonscopies and everything. VATS procedure. Basically they stapled this diaphragm. I'll show you what that staple did. So basically you see the staple line, you see the fenestration over there.
And this is what we kind of mobilized this. So this is what we're doing. We, I'm not doing this case. My hetic surgeon is with me. I really did so many diaphragm cases with my hands. I agree with Roman. 105% more than a hundred. It's very tedious to do laparoscopy, hand stick surgery on diaphragm. It's best with, I'm so convinced I'm sold to it with this case, I'm also sold to a robot because you'll see what happened. So this is green line is our dissection. The yellow line is staple line. The guy stapled. And I think I really despise people who use staples on diaphragm, indiscriminate, very crude procedure. But there is a hole there. But this is our further dissection line going to go. And this is a tented structure. What is that tented structure? Anyone that could be, it's a very deadly one. Guys.
We did not bleed more than 300 cc. And this patient is doing excellence. Im just telling you. Can you imagine this? The worst area to reach. Basically all options could have been massive lap. Put the hand there and press and then did the rip however you can. I never seen it, but this patient did very well. And I mean I have iliac vein hits like this that these are old cases, but basically you got to be very careful. The patient is T-Bird position. You may have one nick there. She will not bleed because of the position and you have intraabdominal pressure. She may not bleed. But then you put the head up, bang, it pulls. So this is one of those cases you see that little hole vascular surgeon, where is vascular surgeon surgery? This could be seven o'clock at night. You may be having glass of wine, whatever.
So you got to know how to stitch. If you don't know how to stitch, you can't do that. So mobilize it. I stitched this and everything went fine. I have couple cases like that, these two, three cases like this. But the reason it is the instrument tip, you have to be very careful. That's why in also robotics and everything, that robot tip did the hit on Thea. Guys, I'm going to, I mean this was from years ago, 10 years ago. This was a great people Deko and Philip Conex published this research review, consistent 10% complication rate. And then Roman did publish too. He has less checkon. He said, I do my ileostomy, my complication rate is less. But overall he has other issues with the ileostomy. Nobody. But overall, this is from American College of Surgeons cohort study for complication following colorectal resection for endometrial almost 755 cases. They have 13.5% complication rate is the previous endosurgery. Hysterectomy is an excellent setup. So just warning you. Okay, I want to thank you for everything. This is my another crazy hobbies. I have done Gyrocopter flying, which we did before. And I want to share you, I want to thank you very much. I want to thank thank Dr. Armand Chu. I want to keep the.
