Selective Removal of Endometriotic Lesions Using CUSA Clarity in Ovarian Endometriomas: A Case-Based Histopathological Study

Objective: To evaluate the feasibility of selective removal of endometriotic lesions using the Cavitron Ultrasonic Surgical Aspirator (CUSA Clarity) in ovarian endometriomas, with a focus on histological preservation of normal ovarian tissue. Methods: We analyzed tissue from a woman in her early 30s who underwent laparoscopic surgery for an ovarian endometrioma measuring approximately 7 cm after preoperative dienogest therapy. Resected cyst wall specimens were divided into five parts, each assigned to a Tissue Select setting (0-4). Samples were scraped with CUSA, followed by histological and immunohistochemical evaluation (H&E, Sirius Red, CK7, CD10). Results: Endometriotic lesions (epithelial and stromal cells) were effectively removed across all settings. At higher Tissue Select settings (3-4), preservation of surrounding tissue was superior, with minimal vacuolization compared to lower settings (0-2). Primordial follicles were observed approximately 600 um beneath the surface, highlighting the importance of limiting cavitation depth. Conclusion: CUSA Clarity enabled selective removal of endometriotic lesions with relative preservation of normal ovarian tissue, particularly at higher Tissue Select settings. This novel approach may represent a fertility-preserving alternative to cystectomy or laser ablation in the management of ovarian endometriomas. Further studies are warranted.