Laparoscopically-assisted transvaginal ethanol sclerotherapy for women with endometrioma

手術手技 卵巣子宮内膜症性嚢胞に対する腹腔鏡補助下経腟超音波ガイド下エタノール固定術 2025 年 41 巻 1 号 p. 213-218 詳細 抄録 Ovarian endometrioma is an ovarian cyst formed when endometrial tissue grows on the surface of the ovaries, often leading to chronic abdominal pain and fertility problems. This study evaluated the technique and efficacy of transvaginal ethanol sclerotherapy under laparoscopic supervision for the treatment of endometrioma. The procedure involves transvaginal ultrasound-guided aspiration and washing of cyst contents, followed by injection of ethanol, which is allowed to sclerose the cyst wall over a period of seven minutes. Laparoscopic surgery is then performed for partial resection and biopsy of the cyst wall and removal of the endometriotic lesion and adhesiolysis of the peritoneal cavity. Normal saline is used to fill the peritoneal cavity, preventing ethanol leakage and minimizing the risk of adhesion formation. This approach aims to reduce cyst size, alleviate pain, and preserve ovarian function, which is crucial for maintaining fertility. Our findings suggest that this technique may be particularly appropriate for unmarried, nulliparous women and in cases where ovarian function decline is anticipated, as it offers a favorable balance between symptom relief and fertility preservation. In addition, the combination of this procedure with postoperative hormonal therapy has been suggested to reduce the recurrence rate of endometriotic cysts, potentially leading to favorable long-term outcomes. Despite these promising results, the potential risks, such as ethanol leakage and its effect on ovarian tissue, require further investigation. Further research is needed to refine this technique, evaluate long-term recurrence rates, and develop optimized postoperative management strategies to improve patient outcomes. © 2025 日本産科婦人科内視鏡学会