Design: Not applicable.

Setting: In this video, the patient underwent laparoscopic partial liver and enbloc partial anterior abdominal wall resection for excision of hepatic endometriosis utilizing the dorsal lithotomy position with moderate reverse Trendelenburg tilt.

Patients or Participants: Our 43-year-old patient presented with a 7-year history of worsening cyclic right upper quadrant pain in the setting of long-standing dysmenorrhea and chronic pelvic pain. Her symptoms were refractory to medical management. After extensive workup and multidisciplinary consultation, clinical diagnosis of hepatic endometriosis was made. Due to the debilitating pain, the patient opted for diagnostic laparoscopy with partial liver resection to remove the suspected lesion.

Interventions: This procedure utilized laparoscopic intracorporeal ultrasound to delineate and confirm the margins of the hepatic endometriosis lesion to ensure complete resection. A wedge resection of the liver enbloc with the abdominal wall was then performed using the ultrasonic scalpel. Lastly, argon beam ablation was used for treatment of the resection bed as well as the abnormal fibrinous-appearing liver surface surrounding the lesion. Patient also underwent a concurrent uncomplicated total laparoscopic hysterectomy with bilateral salpingectomy and excision of endometriosis for treatment of adenomyosis and pelvic pain.

Measurements and Main Results: We demonstrated a minimally invasive surgical approach for complete resection of symptomatic hepatic endometriosis. Patient tolerated the procedure well. Postoperative recovery was uneventful. Pathology confirmed hepatic endometriosis and patient reported complete resolution of her right upper quadrant pain at her 8 week follow up visit.

Conclusion: Hepatic endometriosis is one of the rarest conditions with only limited number of cases reported. Diagnosis and management of hepatic endometriosis requires high level of clinical suspicion as well as multidisciplinary collaboration. In patients with symptoms refractory to medical management, surgical intervention remains essential.