Design: This is a single patient surgical video.

Setting: This case was performed at an academic medical center in an urban setting. Prior to surgery, the patient was brought to the operating room and placed under general endotracheal anesthesia. She was maintained in dorsal lithotomy position using stirrups and had tucked arms throughout the case.

Patients or Participants: This video involves a single patient case study.

Interventions: This patient underwent a robotic assisted laparoscopic excision of endometriosis involving the rectovaginal space. During the case, she required a low anterior resection by colorectal surgery and vaginal resection.

Measurements and Main Results: After these surgical interventions, there was no visible or palpable endometriosis. The goal of our case was to alleviate pain symptoms and normalize anatomy. This patient continues to be followed by Minimally Invasive Gynecology.

Conclusion: This video demonstrates a case of deep infiltrative endometriosis and highlights the importance of both the physical exam in diagnosis and treatment of deep infiltrative endometriosis.