Design: Video of surgery that took place in February 2024, in a private hospital, in São Paulo.

Setting: Female, 33 years old. Five years with pelvic pain and deep dispareunia, with no improvement with hormones. Pelvic examination: Bilateral thickening of the uterosacral ligament and painful retrocervical nodulation. Pelvic MRI: endometriosis in posterior pelvic compartment.

Patients or Participants: Patient coming from a private medical office, undergoing treatment for deep endometriosis through minimally invasive surgery.

Interventions: Surgical treatment was chosen, which involved excision of the endometriosis foci at posterior compartment and intestinal nodulectomy.

Measurements and Main Results: The surgery took place in February 2024, laparoscopically, lasting 50 minutes. Excision of endometriosis foci and intestinal nodulectomy were performed. During the dissection of the left medial pararectal space, anatomical variation of the inferior hypogastric plexus was evident: the hypogastric nerve was cranial and short. There was an accessory hypogastric nerve. There was duplication of the bladder branches. The rectal and vaginal branches departed from a single trunk. There were no intraoperative complications and the patient evolved well post-operatively. In a period of 3 months of follow-up, the patient did not present voiding, evacuation or vaginal dysfunctions.

Conclusion: The branches of the inferior hypogastric plexus display large individual variations, which brings challenge to the surgery and could have clinical impact on the postoperative function of the pelvic organs.