Seckin Aqua Blue Excision Technique

Laparoscopic deep excision surgery is currently the “gold standard” technique for the diagnosis and treatment of endometriosis. The proper use of laparoscopic deep excision surgery depends on the ability to clearly see all endometriosis lesions. With standard laparoscopy, the reflection from the endoscopic light often obscures visualization. The Seckin Aqua Blue Contrast (ABC) technique solves this problem. It provides excellent contrast and clear differentiation of endometriosis lesions from other healthy tissue. It also offers better visual feedback about the size and number of lesions to the surgeon.

Limitations of current techniques

Compared to ovarian and deep-infiltrating endometriosis (DIE), peritoneal endometriosis is difficult to diagnose with imaging techniques such as magnetic resonance imaging or ultrasound. Peritoneal endometriosis consists of both pigmented and non-pigmented lesions. The non-pigmented lesions are particularly difficult to see under normal operating light. This means that even experienced surgeons can fail to detect and address these types of lesions.

This often translates to less overall pain relief and increased time to symptom recurrence. Patients will then undergo additional surgeries. Leaving even just one small non-pigmented lesion can make a difference.

Enhanced visualization strategy with Aqua Blue ContrastTM (ABC)

Classic endometriosis lesions are typically black or red and text books often describe them as a “powder burn”. These lesions are relatively easier to identify during laparoscopy. On the other hand, pelvic anatomy is marked by underlying red and yellow hues that make it difficult to see non-pigmented lesions.

Dr. Seckin’s Aqua Blue ContrastTM (ABC) technique uses methylene blue dye. The natural blue color of this dye helps filter red, yellow, and white colors reflecting from the peritoneum and makes lesions more visible to the naked eye. This combined with magnification from an advanced laparoscopic camera greatly enhances detection.

Seckin Aqua Blue Excision (ABC) technique

The Aqua Blue solution contains 1% methylene blue diluted in sodium chloride. After visual inspection of the peritoneum under a laparoscope, the surgeon submerges the organs with Aqua Blue to assess the full architecture of the endometriosis lesions. This solution is further used to distend the retroperitoneum for visualization.

The surgeon can excise all the lesions using cold excision and send the samples for histopathological examination, thus providing final confirmation of the disease.

Significant improvements with the Seckin Aqua Blue Excision technique

A retrospective study of patients who had endometriosis surgery between 2014 and 2015 showed that the use of the Aqua Blue ContrastTM technique (ABCT) resulted in significantly improved outcomes.

In this study, the first group of patients included patients who had standard laparoscopic endometriosis surgery without using ABCT. The second group had ABCT applied on both pelvic side walls but not in the cul-de-sac or rectouterine pouch. The third group had ABCT applied to all areas in the peritoneal cavity.

After a five-year follow-up period, patients in the first group had an 11.9% recurrence rate of endometriosis symptoms within three years and a 16.1% recurrence rate after five years. These recurrence rates came down to 8.7% and 12.1% in the second group and 3.2% and 4.3% in the third group.

From these findings, ABCT improved identification and excision of endometriosis lesions. Dr. Seckin notes that the excision rates also increased 2.13 fold with ABCT compared to surgery without it. ABCT also minimized disease recurrence by identifying a greater number of lesions in the cul-de-sac.

The Seckin Aqua Blue Excision technique has USPTO recognition

The Seckin Aqua Blue Excision technique is recognized by the US patent and trademark office (USPTO). Once taught, it is easy to perform by many advanced laparoscopic surgeons. This technique is low-cost and is safe to use without any side effects.

It has, so far, been applied to well over 1000 patients for easy visualization of early endometriosis lesions by the surgeons at the Seckin Endometriosis Center.

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