Design: Case report illustrated with video.

Setting: Patient under general anesthesia, placed in lithotomy position, with arms alongside the body and legs 80 degrees abducted in adjustable stirrups. Three robotic arms were used, one for optics inserted through the umbilical scar, and two incisions on the right and left flanks for robotic forceps. Additionally, laparoscopic assistance was provided on the right flank. The cervix was manipulated with a disposable uterine manipulator.

Patients or Participants: Female, 32 years old, with intense chronic pelvic pain, dyspareunia and abdominal distension, mainly during menstrual period. She denied comorbidities and had only a bariatric surgery previously. On physical examination, a 5mm nodule was found in the right posterior fornix of the vagina, without lesions on rectal examination. An MRI showed a retrocevical lesion measuring 2.7 cm, extending to the uterosacral ligaments bitarally, besides bilateral endometriomas and a retraction in the anterior wall of the rectosigmoid measuring 2.3 cm, 12 cm from the anal verge, reducing the lumen of the loop by about 20%.

Interventions: Oophoroplasty and excision of periureteral endometriotic foci on the right, as well as anterior and posterior pelvic compartments, including rectosigmoidal approach.

Measurements and Main Results: The procedure lasted for 4 hours with minimal bleeding. The patient had a good postoperative recovery and was discharged 2 days after surgery. The patient became pregnant 4 months after the surgery.

Conclusion: In this case, we observed the advantage of robotic surgery for fine dissection of structures, as well as the surgical ease with robotic instruments, bringing greater agility and safety to the procedure. The successful surgical outcome enabled the patient to have a pregnancy.