# Transvaginal sonography-guided aspiration of benign ovarian cysts: a retrospective evaluation of safety, feasibility, and economic and environmental implications

## TL;DR

Transvaginal sonography-guided aspiration of benign ovarian cysts is a safe and feasible alternative to surgery, with potential economic and environmental benefits.

## Contribution

This study evaluates the safety, feasibility, and environmental impact of transvaginal sonography-guided aspiration as an alternative to minimally invasive surgery for benign ovarian cysts.

## Key findings

- The procedure was technically feasible in 95% of cases with no major complications.
- One cyst recurrence (4.5%) was observed during follow-up.
- Laparoscopic procedures have higher healthcare costs and a carbon footprint of ~42 kg CO2e, while sonography-guided aspiration has no available data.

## Abstract

To evaluate the safety, feasibility, and short-term reliability of transvaginal sonography-guided ovarian cyst aspiration in women with benign-appearing ovarian cysts and to explore its potential economic and environmental implications compared with minimally invasive surgical management.

This retrospective cohort study included women with sonographically benign ovarian cysts treated with transvaginal sonography-guided aspiration at a tertiary-care hospital between January 2024 and October 2025. Patient characteristics, cyst morphology according to International Ovarian Tumor Analysis (IOTA) Simple Rules, procedural feasibility, complications, and recurrence rates were analyzed. In addition, targeted literature reviews were performed to contextualize reported health care costs and carbon footprints of laparoscopic gynecologic procedures.

Twenty-two women were included. The median age was 58 years (range 31–87), the median cyst diameter was 5.9 cm (range 2.8–10.0), and the median aspirated volume was 55 mL (range 9–600). All cysts fulfilled benign sonographic criteria, most commonly IOTA pattern B1 (77.3%), and were predominantly located in the Douglas space (77.3%). The procedure was technically feasible in 95% of cases and was performed under local anesthesia in all but one patient. No major intra or post-interventional complications occurred. One cyst recurrence (4.5%) was documented during follow-up, noting that most patients were assessed only via self-presentation. Literature data indicate substantially higher health care costs for laparoscopic and robotic gynecologic procedures compared with sonography-guided interventions. Published studies report a mean carbon footprint of approximately 42 kg CO2e per laparoscopic procedure, while no data are currently available for sonography-guided cyst aspiration.

Transvaginal sonography-guided ovarian cyst aspiration appears to be a safe and feasible treatment option for carefully selected benign ovarian cysts, with low short-term recurrence and minimal morbidity. Available evidence suggests potential economic advantages and a likely lower environmental impact compared with minimally invasive surgery. Given the small sample size, this approach should be considered a complementary or alternative option in selected patients rather than a first-line treatment and warrants further evaluation in larger prospective studies.