In this video presentation, we demonstrate the technique of laparoscopic excision of endometriotic nodule of bladder which invaded the full thickness of the muscularis without breaching the mucosal layer of the bladder. Careful shaving of the nodule without breaching the mucosa of the bladder is achievable.

Endometriosis of the bladder is rare. The patients with bladder endometriosis are more likely to have advanced endometriosis with rectovaginal lesions1-3.
Case report:
A 33 years nulliparous, woman presented with dysuria, suprapubic pain and frequency. She also had complaints of dysmenorrhoea, dyschezia and dyspareunia. Ultrasound and MRI revealed hypoechoic nodule between bladder and uterus which was indenting the bladder. Cystoscopy revealed extravesical lesion pushing into the bladder.
At laparoscopy, there was a 3 cm endometriotic nodule with deep scarring in the uretrovasical pouch and advanced deep endometriosis with rectovaginal nodules. Two stage operation was planned. Laparoscopic excision of retroperitoneal endometriosis mass in the Uterovsical pouch (stage 1) and Laparoscopic radical excision of endometriosis, rectal shaving and excision of rectovaginal nodule (stage 2) was performed. At follow-up, she had no urinary symptoms and she made significant improvement in pain scores.
The video (stage 1) demonstrate sharp dissection of vesicouterine space with separation of the bladder from the uterus. Bladder nodule of 3cm was reaching upto the mucosa. Methylene Blue dye in the bladder helped to delineate the musculrais from the bladder mucosa. We will demonstrate excision of the nodule from the muscularis of bladder sparing the unaffected mucosa. The muscularis was then stitched with vicryl 2/0 in two layers.