Design: Surgical video

Setting: Academic hospital

Patients or Participants: Single case report

Interventions: Robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, cystoscopy, insertion of bilateral ureteral stents with ICG dye injection, and low anterior resection with colorectal anastomosis by colorectal surgery.

Measurements and Main Results: Surgical completion of a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, excision of ureteral endometriosis and low anterior resection. Steps reviewed for ICG dye injection. Instructional video on excision of ureteral endometriosis and low anterior resection.

Conclusion:

Bilateral ureteral stents with retrograde injection of ICG can be helpful with rapid visualization of the ureters for Stage IV endometriosis surgery involving the rectosigmoid colon. Multidisciplinary care with colorectal surgery and urology is paramount for complex cases involving the rectosigmoid colon and ureter. Bowel segmental resection and anastomosis is a surgical option for deep infiltrating endometriosis involving the GI tract