Ultrasonic Surgical Aspiration (CUSA®) For Laparoscopic Excision Of Endometriosis: A Prospective Case Series Demonstrating Safety And Precision In Fertility-Preserving Surgery

Background/objectives: Endometriosis affects ~10% of women of reproductive age, often causing chronic pelvic pain and infertility. Conventional energy devices risk thermal injury and bleeding, particularly in fertility-preserving surgeries. The Cavitron Ultrasonic Surgical Aspirator (CUSA®) selectively fragments tissue with minimal thermal spread. This prospective case series evaluates CUSA’s safety and effectiveness in endometriosis surgery. Methods: Fifteen women with suspected peritoneal, deep-infiltrating, or diaphragmatic endometriosis underwent laparoscopic excision exclusively using CUSA at a single center (Jan 2024–Jan 2025). Outcomes included operative time, blood loss, pain score change, recovery time, and complications. Results: Mean CUSA time was 8.5 ± 3.0 min with a median blood loss was less than10 mL. No intraoperative complications or conversions occurred. Surgeon-reported performance scores demonstrated high procedural efficiency and manageable technical challenges. Numeric Pain Rating Score decreased by 3.2 points from 6.9±1.4 to 3.7±1.0, indicating marked symptom relief. All patients resumed daily activities within 3 days. Histology confirmed endometriosis in all cases. Conclusions: CUSA enables safe, precise, and low-blood-loss excision of endometriosis with rapid recovery and significant pain reduction. Its precision and minimal thermal spread make it ideal for fertility-preserving surgery. Larger multicenter studies should assess long-term reproductive outcomes.