Design: Case report

Setting: Academic hospital, main OR, dorsal lithotomy position

Patients or Participants: A single patient, 23 year old G0 with a past medical history of extensive endometriosis involving the uterus, b/l adenexa, bladder, rectum, and diaphragm who presented for surgical management of her endometriosis symptoms.

Interventions: We present a review of the critical anatomy for resection of bladder endometriosis. We also demonstrate the utility of simultaneous cystoscopy and laparoscopy during the resection of bladder endometriosis. Cystoscopic guidance offers the surgeon three main advantages; assistance in identification of lesion borders, identification of key bladder structures allowing the surgeon to determine the involvement in the lesion, and distension of the bladder to create physical space between the lesion and surrounding healthy structures, allowing for safe dissection.

Measurements and Main Results: Bladder endometriosis nodule excised without unintended injury to surrounding structures. Final pathology consistent with 3cmx5cmx2cm endometriosis lesion involving the full thickness of the bladder wall.

Conclusion: A cystoscopic assisted laparoscopic excision of bladder endometriosis allows the surgeon technical advantages in both identification of anatomy and dissection of bladder endometriosis.