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Subfascial endoscopic perforator surgery (SEPS) is a minimally invasive surgical technique primarily used to treat venous insufficiency and varicose veins by targeting perforating veins that contribute to the pathophysiology of venous reflux. The procedure is carried out using small incisions and an endoscope, which allows for a direct visualization of the deep venous system without the need for extensive skin dissection. During SEPS, a camera is inserted through these small incisions, providing the surgeon with a detailed view of the anatomical structures surrounding the perforators. This technique has gained popularity due to its ability to minimize morbidity associated with traditional open surgery, such as scarring and recovery time while maintaining a high level of efficacy in reducing symptoms associated with venous disease. The basic principle involves isolating and interrupting the incompetent perforator veins, which are responsible for the upward flow of venous blood from the superficial venous system to the deep venous system, ultimately contributing to venous hypertension. By dissecting these perforators under endoscopic guidance, surgeons can safely ligate or remove them, thus improving blood flow dynamics and alleviating symptoms such as swelling, pain, and ulceration in affected limbs. One of the key advantages of SEPS is its ability to help preserve surrounding tissues, reduce postoperative pain, and enhance patient recovery, as the need for large incisions is eliminated. Additionally, the use of endoscopy allows for a more precise and controlled approach, resulting in fewer complications such as infection and hematoma formation. Patients undergoing SEPS typically experience a rapid return to normal activities, often within days, compared to weeks for traditional surgical methods. Moreover, the cosmetic outcomes are generally superior due to minimal scarring, which is a significant consideration for many patients. As a result, SEPS has been shown to be an effective option for those who suffer from chronic venous insufficiency and related conditions, particularly in cases where conservative management options have failed. The harmonic scalpel and other advanced technologies have further enhanced the effectiveness and safety of the procedure by ensuring precise tissue dissection and simultaneous coagulation, thereby reducing intraoperative blood loss and enhancing recovery. Overall, subfascial endoscopic perforator surgery represents a significant advancement in the treatment of venous disorders, combining effectiveness with the minimally invasive benefits that contemporary patients seek. The ongoing research into long-term outcomes and refinement of techniques continues to support its growing role in the field of venous surgery, providing a valuable option for patients seeking relief from chronic venous issues and improving their quality of life.