ORIGINAL RESEARCH article
Front. Surg.
Sec. Obstetrics and Gynecological Surgery
This article is part of the Research TopicThe Integrative Role of Gynecological Ultrasound in Surgical Planning and Treatment of EndometriosisView all articles
Ultrasonic Surgical Aspiration (CUSA®) for Laparoscopic Excision of Endometriosis: A Prospective Case Series Demonstrating Safety and Precision in Fertility-Preserving Surgery
Provisionally accepted
- 1Unidade Local de Saúde Viseu Dão-Lafões, Viseu, Portugal
- 2Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal
- 3Universidade do Porto Instituto de Ciencias Biomedicas Abel Salazar, Porto, Portugal
- 4Centro Materno Infantil do Norte (CMIN), Unidade Local de Saúde Santo António, Porto, Portugal
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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.
Keywords: Endometriosis, laparoscopic surgery, Cavitron ultrasonic surgical aspirator (CUSA), Fertility Preservation, Energy-based surgical devices, Thermal injury, Minimally invasive gynecology
Received: 30 Oct 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Vieira-Coimbra and Ferreira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Márcia Vieira-Coimbra
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