Robotic Ethanol Sclerotherapy for Ovarian Endometrioma: A safer, fertility-preserving alternative to traditional cyst removal

What is an ovarian endometrioma?

An ovarian endometrioma (often called a “chocolate cyst”) is a cyst caused by endometriosis involving the ovary.

These cysts can lead to:

• Chronic pelvic pain
• Painful periods
• Pain with intercourse
• Difficulty falling pregnant
• Progressive damage to ovarian tissue

Traditional treatment involves laparoscopic cystectomy (stripping the cyst wall). While effective, this can unintentionally remove healthy ovarian tissue and reduce ovarian reserve.

What is Robotic Ethanol Sclerotherapy?

Robotic ethanol sclerotherapy is a minimally invasive, ovarian-sparing technique designed to treat endometriomas while preserving fertility.

Instead of removing the cyst wall, the procedure involves:

1. Creating a small opening in the cyst
2. Aspirating the cyst contents
3. Irrigating the cyst cavity
4. Instilling 96% ethanol into the cyst
5. Allowing controlled exposure (~10 minutes)
6. Removing the ethanol and rinsing the cavity

The ethanol works by destroying the cyst lining, reducing recurrence while preserving surrounding healthy ovarian tissue.

Performed robotically, this technique allows:

• Exceptional precision
• Magnified 3D visualisation
• Gentle tissue handling
• Simultaneous treatment of deep endometriosis

Why consider this technique?

1. Preserves ovarian reserve

Unlike cystectomy, which can remove normal ovarian tissue:

• Minimises damage to healthy ovary
• Better preservation of ovarian reserve (AMH)

2. Fertility-focused approach

Particularly beneficial for women planning pregnancy:

• Improved egg yield in IVF cycles
• Better preservation of ovarian function
• Avoids repeated ovarian surgery

3. Comparable effectiveness

• Effective symptom relief
• Recurrence rates comparable to cystectomy in selected patients

4. Less surgical trauma

• Avoids stripping of ovarian cortex
• Minimal use of cautery
• Reduced bleeding
• Lower adhesion formation

5. Ideal for complex endometriosis surgery

Unlike ultrasound-guided techniques:

• Allows complete pelvic assessment
• Enables treatment of deep infiltrating endometriosis at the same time
• Integrates seamlessly with advanced robotic surgery

Who is this suitable for?

Robotic ethanol sclerotherapy may be ideal for:

• Women with low ovarian reserve
• Patients planning IVF or future pregnancy
• Recurrent endometriomas
• Bilateral ovarian cysts
• Patients undergoing surgery for advanced endometriosis

When is cystectomy still recommended?

This technique is not suitable for all patients. Traditional cyst removal may be preferred when:

• There is suspicion of malignancy
• The cyst appears atypical on imaging
• Prior failed sclerotherapy
• Histological diagnosis is required

A balanced, personalised approach

Treatment of ovarian endometriomas requires careful balance between:

• Removing disease
• Preserving ovarian function
• Optimising fertility

Robotic ethanol sclerotherapy represents a modern, conservative alternative – particularly valuable in carefully selected patients where ovarian preservation is a priority.

Key Takeaway

Robotic ethanol sclerotherapy is a safe, fertility-preserving alternative to cystectomy—offering effective treatment while protecting long-term ovarian function.