Design: Case presentation of laparoscopic excision of bilateral ureteral endometriosis in stage four endometriosis

Setting: Operating room; Urology consulted prior to scheduled surgery. The video is in the setting of laparoscopy with the patient in dorsal lithotomy position.

Patients or Participants: Case presentation of one patient; follow up includes post operative visits with Urology and MIGS departments, and imaging with radiology.

Interventions: Total laparoscopic hysterectomy, bilateral salpingectomy, right oophorectomy, bilateral ureterolysis, lysis of adhesions, excision of endometriosis

Measurements and Main Results: After the above intervention, patient underwent left retrograde pyelogram four weeks post-operatively, which demonstrated an area of distal left ureteral narrowing however no hydronephrosis and normal ureteral efflux. At five weeks post-operatively, renal ultrasound demonstrated normal kidneys with no hydronephrosis and normal ureteral jets bilaterally.

Conclusion: We recommend the following to assist in complex cases that involve ureteral endometriosis; Delineating the anatomy first by tagging the ureters with vessel loops, securing blood supply by ligating the uterine arteries at their origin, and if part of the surgical plan, removing the uterus to allow for improved visualization. Lastly, we appreciate collaborating with Urology colleagues for cases involving ureteral endometriosis.