A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Stage III Peritoneal Endometriosis

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 903–914

DOI: 10.46882/2026/IJOG/000556

Original Research Article

Title: A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Stage III Peritoneal Endometriosis

Names of Authors: Olayinka O. Cole¹, Nesta C. Chuka¹

Authors’ Affiliations:
¹ Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria

Abstract:
Pelvic endometriosis causes chronic severe pelvic pain and dysmenorrhea, requiring precise targeted destruction of lesions. This randomized, open-label clinical trial compared the 1-year therapeutic efficacy, improvements in quality of life scores, and complications of non-invasive ultrasound-guided High-Intensity Focused Ultrasound (HIFU) thermal ablation against standard Laparoscopic Ablation/Excision (LA) for symptomatic stage III peritoneal endometriosis. One hundred premenopausal women with laparndoscopically or MRI-confirmed stage III pelvic endometriosis presenting with severe refractory pain were randomized into two equal treatment arms (n = 50 per group). The primary outcomes checked at 12 months were reductions in pain visual analog scale (VAS) scores and updates on the Endometriosis Health Profile (EHP-30) questionnaire. At 12 months post-intervention, both groups demonstrated a substantial reduction in mean chronic pelvic pain VAS scores from baseline (p < 0.001), with no significant difference between the two cohorts (HIFU: -4.2 ± 1.1 points; LA: -4.5 ± 1.3 points, p = 0.18). Quality of life indexes on the EHP-30 improved equivalently across both arms (p = 0.24). However, the HIFU cohort experienced significantly shorter operational recovery timelines, with a median length of hospital stay of 6 hours compared to 48 hours for the open surgical LA group (p < 0.001). Major procedural complications were absent in the HIFU group but occurred in 6.0% of the laparoscopic group (p = 0.041). Non-invasive HIFU thermal ablation offers chronic pain relief and quality of life improvements equivalent to laparoscopic surgery for stage III peritoneal endometriosis while achieving significantly shorter hospital stay requirements.

Keywords: Peritoneal Endometriosis; High-Intensity Focused Ultrasound; Laparoscopic Ablation; Chronic Pelvic Pain; Quality of Life; Thermal Destruction.

Manuscript Timeline: Received: August 08, 2026; Revised: September 06, 2026; Accepted: September 16, 2026; Published: September 26, 2026.

Citation: Cole OO, Chuka NC. A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Stage III Peritoneal Endometriosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 903–914.

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