Design: Edited step-by-step video of removing posterior compartment endometriosis with underlying connective tissue using en bloc peritonectomy.

Setting: Videolaparoscopic surgery with four French-style trocars using the latest generation of ultrasonic scissors for dissection, excision and hemostasis.

Patients or Participants: A usual case of 31 yo patient AAGL grade Ill endometriosis with chronic pelvic pain and 5 years "no cause" infertility.

Interventions: Considering endometriosis as a involvement of the pelvic layers by remnants of Mullerian ducts, a systematized technique of en bloc excision with wide non-oncological removal of the peritoneum, or peritonectomy. The step-by-step procedure is described in detail.

Measurements and Main Results: In this educational video, it is possible to see by the step-by-step process of endometriosis resection in a wide and deep way that could be reproduced and applicable. It is also possible to observe the release of the deep fascias by entrapment caused by endometriosis over the somatic innervation such as the lumbosacral trunk. Also understanding the concept of "marble" in which endometriosis is actually a diffuse infiltration within the connective tissue instead of a superficial spot in the peritoneal surface. Hemostasis and tissue vitality can be reached at the end of the procedure after applying concepts of neuropelveology and proper vascular control with rational and delicate use of the ultrasound energy device.

Conclusion: Improvement of chronic pelvic pain should be achieved by removing all endometriosis and fibrosis affecting the peritoneum and deeper fascias, thus freeing the somatic nerves and the inferior hypogastric plexus from entrapment. Fertility can also be improved by this technique, as it drastically reduces the immunologic cross-talk between the endometrium-like tissue and the proper intrauterine endometrium responsible for nidation.