Design: This is a single-case study with a detailed description of it's laparoscopic management.

Setting: Tertiary care referral centre in MIGS, Mumbai, India

Patients or Participants: 31-year-old female with severe dysmenorrhea and lower abdominal pain during defecation and urination for 3 months. A transvaginal ultrasound & MRI suggested a left ovarian endometriotic cyst and evidence of rectovaginal endometriosis with uterine caesarean scar endometriosis

Interventions: Key Steps - Sigmoid mobilisation, bowel adhesiolysis, use of dilute Vasopressin for laparoscopic uterine scar endometriosis excision with layered closure of the defect with barbed sutures with uterine manipulator in situ. Bilateral ovarian cyst drainage & cystectomy with ovarian suspension for medial para-rectal space dissection, ureterolysis with excision of diseased peritoneum with uterosacral excision. After lateral dissection, midline rectovaginal space dissection. with use of rectal probe with rectovaginal nodule excision by rectal shaving technique & complete butterfly peritonectomy. Rectal integrity confirmation with air leak test with retrieval of excised nodules, cyst walls & affected peritoneum which were excised followed by cystoscopy to check for ureteric jets.

Measurements and Main Results: Key measurements included the successful completion of the laparoscopic procedure and postoperative outcomes. The
patient experienced good outcomes postoperatively, with resolution of symptoms and no reported complications.

Conclusion: This video case presentation highlights the successful management of a rare case of isolated uterine scar endometriosis associated with rectovaginal endometriosis using laparoscopic techniques.