Design: Surgical video.

Setting: Tertiary care center operating room.

Patients or Participants: We present a 41 y/o G0 with endometriosis, chronic pelvic pain, dyspareunia and pain with defecation. She had a previous robotic hysterectomy, bilateral salpingectomy, left oophorectomy and right ovarian cystectomy for treatment of her endometriosis. Preoperative TVUS and MRI revealed deep infiltrating endometriosis of the vaginal cuff and rectosigmoid colon, with a left ovarian remnant and a large right endometrioma. The area of concern was predicted to require low anterior resection with bowel reanastamosis.

Interventions: Definitive surgical management.

Measurements and Main Results: The patient underwent a post-hysterectomy robotic assisted double discoid resection of bowel endometriosis as well as right oophorectomy, left ovarian remnant resection and vaginal cuff endometriosis resection. Surgical intervention was downgraded from a low anterior resection to a double discoid resection after ultrasound measurement was performed on the lesions. Post-operatively, the patient’s symptoms had resolved.

Conclusion: Robotic integrated ultrasound can help to delineate endometriotic lesions and lead to the decision to downgrade from a low anterior resection to a discoid resection. This can allow for decreased postoperative complication risk without compromising the radicality of disease excision.