Design: Video-documented case report

Setting: Patient under general anesthesia, positioned lithotomy, arms alongside body, legs 80° abducted in stirrups. Indocyanine green was used for better visualization of anatomy and increased surgical efficiency. Main trocars were inserted at the umbilical scar incision for optics, and three other incisions in the bilateral iliac fossa and suprapubic regions were used for accessory trocars.

Patients or Participants: Patient A.L, 34-year-old a woman with dysmenorrhea, dyspareunia, and constipation, diagnosed with endometriosis a year ago. She had unsuccessful clinical treatment and underwent egg freezing previously to preserve her fertility. On physical examination, a lesion in the left parametrium extending to the vaginal mucosa and a palpable nodule 6 cm from the rectal ampulla was found. Transvaginal ultrasound with intestinal preparation showed a 2.6 cm endometrioma on the left, a retrocervical lesion extending to the rectovaginal septum (3.2 cm), and another lesion in the rectum (3.1 cm). Extensive involvement of the left pelvic side was observed, with a lesion in the left pouch of Douglas extending to the left pararectal fossa, involving the inferior hypogastric plexus and sacral nerves at S3 level. Laparoscopic surgery was indicated due to extensive disease involvement, including the ureter, parametrium and bowel.

Interventions: Resection of endometriosis lesions, Left oophoroplasty and Rectosigmoidectomy.

Measurements and Main Results: Patient experienced mild postoperative pain but had no complications, leading to discharge on the second day with normal bowel habits.

Conclusion: Laparoscopic management of endometriosis involving deep pelvic compartments, intestine, ureter, and ovaries yields satisfactory results, with relatively short surgical time (3 hours and 30 minutes), minimal bleeding, and good postoperative recovery.