Design: Video footage illustrating the surgical steps.

Setting: An endometriosis and adenomyosis referral center.

Patients or Participants: The case involves a 36-year-old nulliparous woman with primary infertility, repeated failed IVF cycles, and unsuccessful medical treatment.

Interventions: A preoperative MRI scan identified diffuse adenomyosis involving the anterior and posterior uterine walls, with a thickened junctional zone (>12 mm). An intracavitary diluted indocyanine green (ICG) dye is utilized to maximize the precise excision of adenomyosis tissue while maintaining adequate myometrial residual around the cavity. A double flap technique was performed to excise the adenomyosis tissue and reconstruct the uterine walls.

Measurements and Main Results: N/A

Conclusion: In selected cases, uterus-sparing surgical techniques for diffuse adenomyosis are indicated where medical management fails and repeated IVF cycles are unsuccessful. A double flap approach can be used to excise the adenomyosis tissue while maintaining adequate myometrium. The use of the robotic platform, in conjunction with ICG dye, can facilitate these surgical techniques and potentially improve outcomes.