Video Objective To demonstrate technique for laparoscopic management of abdominal wall endometriosis contained within the rectus muscle. Setting A private practice specialized in the care of women with endometriosis. Interventions A 41 year old woman complained of severe cyclic pain in the abdominal wall. She had had two previous cesarean deliveries, and noted this mass and the resulting pain after the second surgery. The mass was only palpable to her during her menses, but otherwise was not palpable. Previous imaging via MRI demonstrated a mass within the abdominal wall. An outside surgeon had performed a laparotomy but did not encounter any mass to resect, resulting in no improvement for the patient. Review of the images demonstrated that the mass was entirely retrofascial within the rectus muscle, explaining the previous surgeon's failure to find a mass. A laparoscopic approach was discussed with the patient and consent was obtained. At laparoscopy, the mass was entirely resected, including portions of rectus muscle and parietal peritoneum, without the need to breach the rectus fascia. Rectus muscle and peritoneum was brought together over the defect. Conclusion At three months, the patient reports near complete resolution her pain, and a dramatically improved quality of life. Abdominal wall endometriosis is a relatively rare presentation of the disease but presents with some frequency to expert endometriosis practices. In most cases it is the result of iatrogenic seeding of the abdominal wall with native endometrium at the time of cesarean delivery or other surgery. In most cases, subcutaneous tissue and anterior rectus fascia is involved, demanding an open approach to resection. In rare cases such as this, the entire lesion may be under the fascia within the rectus muscle or abdominal obliques, allowing a laparoscopic or robotic approach to full resection. To demonstrate technique for laparoscopic management of abdominal wall endometriosis contained within the rectus muscle. A private practice specialized in the care of women with endometriosis. A 41 year old woman complained of severe cyclic pain in the abdominal wall. She had had two previous cesarean deliveries, and noted this mass and the resulting pain after the second surgery. The mass was only palpable to her during her menses, but otherwise was not palpable. Previous imaging via MRI demonstrated a mass within the abdominal wall. An outside surgeon had performed a laparotomy but did not encounter any mass to resect, resulting in no improvement for the patient. Review of the images demonstrated that the mass was entirely retrofascial within the rectus muscle, explaining the previous surgeon's failure to find a mass. A laparoscopic approach was discussed with the patient and consent was obtained. At laparoscopy, the mass was entirely resected, including portions of rectus muscle and parietal peritoneum, without the need to breach the rectus fascia. Rectus muscle and peritoneum was brought together over the defect. At three months, the patient reports near complete resolution her pain, and a dramatically improved quality of life.