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VIDEO
Minimally Invasive Approach to Deep Endometriosis with
Rectal and Ureteral Involvement
Facundo Montero Quiroga1, Agustín Quintaie2, Guido Koren3, Paul Sereday2, Nicolás Avellaneda4
1Service of General Surgery
2Service of Obstetrics and Gynecology
3Service of Urology
4Service of Colorectal Surgery
Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Ciudad Autónoma de Buenos Aires, Argentina.
LINK
To cite:
Quiroga FM, Quintaie A, Koren G, Sereday
P, Avellaneda N. Minimally Invasive
Approach to Deep Endometriosis with
Rectal and Ureteral Involvement. Rev
Argent Coloproctol. 2026; 37(2):35-36.
Keywords: deep endometriosis; rectal endometriosis; ureteral endometriosis; laparoscopic surgery; ureteral
reimplantation
doi:10.46768/t8cetk11
u
Additional supplemental material, when
rectum. The left ureter was subsequently identified
and dissected free from adhesions to the rectal wall.
INTRODUCTION
applicable, is published online only. To
view, please visit the journal online:
Left oophorectomy was then completed using
combined sharp and energy-based dissection.
Severe endometriotic involvement with extensive
fibrosis was identified in the right ureter. The
affected ureteral segment was transected, the
double-J stent was removed, and the distal ureteral
stump was ligated. Urinary tract integrity was
confirmed with a hydropneumatic test.
Deep endometriosis is
a
severe form of
Received: January 8, 2026
Accepted: April 6, 2026
endometriosis characterized by infiltration of
endometrial tissue more than 5 mm beneath the
peritoneal surface. This condition may involve
pelvic structures such as the rectum and ureters,
leading to severe cyclic pain and urinary or
gastrointestinal symptoms.1,2 Surgical management
of this condition, particularly in cases with rectal and
Right oophorectomy was completed, followed by
resection of an endometriotic implant located on the
cervical stump. Colpotomy and trachelectomy were
then performed, followed by closure of the vaginal
cuff.
ureteral involvement, requires
a
precise
multidisciplinary approach and meticulous
dissection to preserve organ function and minimize
morbidity.3,4 Minimally invasive surgery has
become the preferred approach for complex
endometriosis because of its enhanced anatomic
visualization, reduced postoperative morbidity, and
improved recovery. The present video demonstrates
a highly complex surgical technique, including
rectal mobilization and ureteral reimplantation. This
audiovisual material may provide technical and
educational value to the colorectal surgical
community.
For urinary tract reconstruction, bladder
mobilization
and
laparoscopic
ureteroneocystostomy were performed using
interrupted Vicryl® sutures over a ureteral stent.
The procedure concluded with the placement of a
surgical drain in the operative bed.
The postoperative course was uneventful, and the
patient was discharged on postoperative day 1
without complications. The urinary catheter was
removed 15 days later, and at follow-up, the patient
remained asymptomatic and required no analgesic
medication.
© 2026 Los autores. Publicado por Revista
Argentina de Coloproctología. Este artículo
se distribuye bajo licencia Creative
Commons Atribución–NoComercial–
SinDerivadas 4.0 Internacional (CC BY-NC-
ND 4.0).
VIDEO DESCRIPTION
A 47-year-old woman with a body mass index of 27
kg/m² and no known drug allergies presented with
recurrent cyclic abdominal pain refractory to 3
months of medical therapy. Her surgical history
included subtotal hysterectomy for uterine
leiomyomata, breast reduction surgery, and previous
placement of a right double-J ureteral stent for
hydronephrosis secondary to endometriosis. Given
the absence of future fertility desires, definitive
surgical treatment was indicated.
Standard laparoscopic access was established. Initial
exploration revealed bilateral ovarian endometriotic
implants and dense adhesions involving the rectum
and lateral pelvic walls. Medial dissection of the
sigmoid mesocolon and mesorectum was performed
using energy devices, followed by mobilization of
the ovaries from the anterior surface of the colon and
CONCLUSIONS
Correspondence to
Facundo Montero Quiroga
Minimally invasive surgery for deep endometriosis
with rectal and ureteral involvement is feasible and
safe in selected patients when performed by an
experienced multidisciplinary team. Precise
anatomic identification and meticulous surgical
technique are essential to minimize morbidity,
preserve organ function, and enhance postoperative
recovery.
This case demonstrates the technical feasibility of a
laparoscopic approach that combines adhesiolysis,
adnexal resection, trachelectomy, and ureteral
reimplantation. Satisfactory perioperative and
functional outcomes were achieved, even in the
setting of severe ureteral involvement.
