ArticleFrontiers in surgery2025
Ultrasonic surgical aspiration (CUSA®) for laparoscopic excision of endometriosis: a prospective case series demonstrating safety and precision in fertility-preserving surgery.
Article in Frontiers in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: 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. Material and 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. At the first follow-up visit (6-8 weeks postoperatively), 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. In all patients, all visible lesions suggestive of endometriosis were excised intraoperatively, and histology confirmed endometriosis in all cases. Discussion: CUSA allows precise and safe laparoscopic excision of endometriosis with minimal bleeding, absence of perioperative complications, and significant short-term pain reduction. These findings demonstrate the feasibility and short-term safety of the technique and support its potential value in fertility-preserving surgery. However, given the small sample size, single-center design, and limited follow-up, the results should be interpreted with caution. Future multicenter studies with larger cohorts and reproductive outcome assessment are needed to confirm these preliminary findings.
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