Simultaneous Single-Port Robotic Excision of Diaphragmatic Endometriosis and Mucosa-Sparing Nodulectomy in Rectal Endometriosis

The simultaneous appearance of symptomatic severe pelvic and diaphragmatic deep endometriosis represents a particular challenge in surgical treatment of the disease. We report a symptomatic patient with a history of six previous laparoscopic surgeries for endometriosis who underwent a single-port robotic-assisted complete excision of histopathologically confirmed endometriosis with combined mucosa-sparing rectal nodulectomy and full-thickness resection of the central right diaphragm, performed through a single 3 cm supraumbilical incision. The single-port robotic approach, recently introduced into gynecological minimally invasive surgery, enabled resection of two anatomically distant disease sites—the deep pelvis and the right hemidiaphragm—through one access port without repositioning of the port site. To the best of our knowledge, this is the first case report on simultaneous single-port robotic excision of diaphragmatic and rectal deep endometriosis.