Transvaginal ethanol sclerotherapy for an endometrioma in 10 steps

Objective: To describe a minimally invasive 10-step technique of ethanol sclerotherapy for the treatment of an endometrioma.

Design: Step-by-step video demonstration of the technique.

Setting: University tertiary care hospital.

Patient(s): Women with endometriomas defined as persistent endometriotic ovarian cysts between 25 and 100 mm of diameter, confirmed by magnetic resonance imaging.

Intervention(s): Endometriomas occur in 17%-44% of patients with endometriosis, who generally complain about pelvic pain or infertility. This technique may be offered to patients with endometriomas to preserve fertility. The local institutional review board stated that approval was not required because the video describes a technique and not a clinical case. In our center, all severe endometriosis cases are discussed during a multidisciplinary endometriosis meeting.

Main outcome measure(s): This video presents the procedure divided into the following 10 steps: planning of the surgery; materials; ultrasound examination; transvaginal puncture of the endometrioma; aspiration of the cyst; cytology of the cyst; flushing the cyst with saline solution; injection of 96% ethanol; 10 minutes' exposure to ethanol; and aspiration of ethanol.

Result(s): We presented 10 steps to make the procedure easier to adopt and to reduce the learning curve. This technique may be offered as an alternative to cystectomy.

Conclusion(s): Ethanol sclerotherapy for endometriomas is a rapid outpatient procedure, requiring little equipment for a low cost.