Minimally Invasive Innovation in Endometriosis and Adenomyosis: Toward Fertility Preservation and Symptom Relief

Endometriosis and adenomyosis are two closely related, estrogen-dependent disorders that challenge clinicians with chronic pain, recurrence, and complex fertility implications. The two original articles featured in this issue of Gynecology and Minimally Invasive Therapy reflect the ongoing evolution of conservative, fertility-preserving strategies for these conditions. In the first study, Zhangwei et al. evaluated the combined use of a gonadotropin-releasing hormone agonist with lauromacrogol sclerotherapy for ovarian endometriotic cysts.[] Compared with conventional laparoscopic cystectomy, this minimally invasive protocol demonstrated higher overall efficacy (95% vs. 77.5%), lower recurrence rates, and superior postoperative pain control, all while preserving ovarian reserve. Although sclerotherapy is an established but less commonly adopted approach, its renewed consideration – particularly with the use of lauromacrogol – addresses a key clinical concern: The preservation of ovarian function. By integrating hormonal suppression and local sclerosis to inactivate cyst walls and prevent recurrence, this multimodal strategy provides a valuable alternative for patients at risk of diminished ovarian reserve following surgery.[,] The second study, by Maneerat et al., assessed outcomes of laparoscopic adenomyomectomy in women suffering from adenomyosis and endometriosis-related pain.[] Within 24 weeks postoperatively, more than 96% of patients achieved sustained remission of dysmenorrhea and heavy menstrual bleeding. Although pregnancy outcomes were not reported during the relatively short follow-up period, 42% of patients subsequently pursued assisted reproductive treatment, suggesting a crucial postoperative window for fertility planning. This study reaffirms that uterus-sparing surgery – when executed with precision and surgical finesse – can achieve durable symptom relief even in severe disease. Collectively, these investigations highlight an important clinical paradigm: Minimally invasive, fertility-preserving therapies can deliver substantial symptom control without compromising reproductive potential. The integration of pharmacologic modulation, image-guided intervention, and advanced laparoscopic techniques exemplifies the modern shift from radical excision toward biologic and functional preservation.[,] As minimally invasive gynecologic surgery continues to advance, individualized treatment planning – guided by disease extent, ovarian reserve, and reproductive goals – remains essential. These studies remind us that in managing endometriosis and adenomyosis, precision and restraint often yield the most meaningful outcomes for patients. Author contributions The author has made a substantial contribution to the conception, design, acquisition, analysis, or interpretation of data, drafting or revising the manuscript. The author has read and agreed to the final version of the manuscript. Data availability statement Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgments We would like to thank all staff of the department for their support in this study. REFERENCES 1. Zhangwei S, Lie M, Yan Y, Lingling L. The impact of gonadotropin-releasing hormone agonist combined with lauromacrogol on ovarian reserve function and pain scores in patients with ovarian endometriotic cysts. Gynecol Minim Invasive Ther 2026;15:127–31.2. Frankowska K, Dymanowska-Dyjak I, Abramiuk M, Polak G. The efficacy and safety of transvaginal ethanol sclerotherapy in the treatment of endometrial cysts-a systematic review. Int J Mol Sci 2024;25:1337.3. Lavadia CM, Jeong HG, Ryu KJ, Park H. Ovarian reserve and IVF outcomes after ethanol ovarian sclerotherapy in women with endometrioma:A systematic review and meta-analysis. Reprod Biomed Online 2025;51:104840.4. Maneerat P, Lin WL, Lee CL. Postoperative outcomes on endometriosis-related pain following laparoscopic adenomyomectomy:A retrospective cohort study. Gynecol Minim Invasive Ther 2026;15:121–6.5. Chu Z, Jia L, Dai J, Wu Q, Tian F, Bai S. Effects of different treatment methods on clinical efficacy and fertility outcomes of patients with adenomyosis. J Ovarian Res 2024;17:16.6. Shats M, Zajicek M, Siedhoff MT, Meyer R. Updates on adenomyosis and fertility. Curr Opin Obstet Gynecol 2025;37:198–206.