ObjectiveTo demonstrate the anatomical and technical highlights of nerve-sparing deep endometriosis (DE) surgery with rectal discoid resection using a newer single-port robotic system. DesignStep-by-step demonstration of this method with narrated video footage. SettingAn urban general hospital. Single-port laparoscopic surgery is a useful surgical approach in gynecology because of the excellent cosmetic results, but shows challenges including reduced intracorporeal triangulation and conflict with non-articulating instruments. The range of indications has thus been limited. PatientA 46-year-old woman was referred with severe pelvic pain, dysmenorrhea and pain on defecation. Magnetic resonance imaging revealed uterine adenomyosis, bilateral ovarian endometriomas, and 3 cm of rectal endometriosis. CT colonography confirmed 38% stenosis of the rectum. InterventionA newer single-port robotic system. Main Outcome MeasuresThe technical safety and feasibility of intrapelvic complex DE surgery using a newer single-port robotic platform. ResultsThe procedure was performed using 9 steps with a da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, California). Importantly, the surgical steps were completely identical to conventional multiport laparoscopic or robotic surgery. This suggests that conventional laparoscopic or robotic skills are highly transferrable to the newer system: Step 1, adhesiolysis and adnexal surgery; Step 2, separation of the nerve plane; Step 3, dissection of the ureter; Step 4, reopening of the pouch of Douglas; Step 5, complete removal of DE lesions while avoiding injury to the nerve plane; Step 6, hysterectomy (if the patient desires non-fertility-sparing surgery); Step 7, rectal discoid resection with circular stapler; Step 8, checking for rectal injury using an air leakage test and tissue perfusion; and Step 9, application of barrier agents for adhesion prevention. The newer single-port system offered several advantages, including high-resolution three-dimensional visualization, articulating instruments (intracorporeal instrument triangulation), and improved dexterity and range of motion. These advantages allow precise dissection even in difficult situations such as deep endometriosis. ConclusionsThis appears to be the first reported use of the da Vinci SP for nerve-sparing DE surgery or rectal discoid resection. The newer single-port robotic system can provide the same quality of surgery as conventional multi-port laparoscopic and robotic platforms with cosmetic advantages for the treatment of complex pelvic pathologies.