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STUDY OBJECTIVE The purpose of this study was to evaluate laparoscopic aspiration of endometriomas via 95% ethanol sclerotherapy. DESIGN A single center, retrospective study. SETTING Endometriosis outpatient clinic of a tertiary university hospital, gynecological department of Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy PATIENTS: Fifty-three females with 64 identified endometriomas measuring 4 to 10 cm with no suspected malignancy. INTERVENTIONS Laparoscopic aspiration and 95% ethanol sclerotherapy of endometriomas was completed in patients between September 2013 and September 2017. MEASUREMENTS AND MAIN RESULTS Using standard laparoscopy, ovarian endometriomas were aspirated and washed to remove all cystic material. A 95% ethanol solution was instilled in the cysts and left for 15 minutes, then removed. Patients were followed by ultrasound at 3, 6, 9, and 12 months, and then annually to identify recurrence. All patients were administered postoperative hormone therapy, suspended only in those desiring pregnancy or experiencing side effects. Mean age was 32 (range, 19-40) years, mean cyst diameter was 6 (range, 4-10) cm. Thirteen of the 53 patients (25%) had previous surgery for endometriomas. Forty-one patients (77%) had associated deep endometriosis, treated during the same laparoscopic procedure. No major ethanol-related complications were recorded. Mean length of follow-up was 31 months. Recurrence of endometriomas was observed in 5 patients (9%). Overall pregnancy occurred in 16 of 28 patients (57%) desiring pregnancy. CONCLUSION Laparoscopic aspiration and ethanol sclerotherapy as treatment for endometriomas, even in patients with bilateral endometriomas or with associated deep endometriosis, resulted in <10% recurrence and no major complications.