Endometriosis refers to the presence of endometrial tissue (glandular and mesenchymal) with growth function in the uterine cavity outside of the overlying endometrium and the myometrium, which can grow, infiltrate and bleed repeatedly, forming nodules and masses, causing pain and infertility. According to the “Diagnosis and Treatment Standards of Endometriosis” formulated by the Collaborative Group on Endometriosis of the Obstetrics and Gynecology Branch of the Chinese Medical Association, the clinicopathological types of endometriosis can be divided into Peritoneal Endometriosis (PEM), Ovarian Endometriosis (OEM), Deep Infiltrating Endometriosis (DIE), and Endometriosis of the Ovary. Deep Infiltrating Endometriosis (DIE), and Other Endometriosis (OtEM). The concept of deep infiltrating endometriosis was first introduced in the early 1900s, but was not clearly defined until the 1990s and is still used today.DIE refers to ectopic lesions that infiltrate the retroperitoneum to a depth of R5 mm, often invading sites such as the uterosacral ligament, rectovaginal septum, posterior vaginal vault, rectum and vesicoureter.The exact incidence of DIE is unknown, and some authors have studied surgically treated Some scholars have studied 132 consecutive cases of surgically treated endometriosis and found that the percentage of patients with deep lesions was as high as 33% and intestinal involvement ranged from 14% to 73.3%. In our country, DIE has not received widespread attention from clinicians and, as a result, is often underdiagnosed or misdiagnosed. There is increasing evidence that dysmenorrhea, deep intercourse pain and pain in the rectal area in patients with endometriosis are closely related to these deep ectopic lesions, and to a lesser extent to chocolate cysts. Therefore, cyst debridement alone is clearly not a complete treatment. The presence of deep intercourse pain, painful menstrual bowel movements, even mucus or bloody stools, chronic pelvic pain (CPP), and hydronephrosis or rectal stenosis in patients with endometriosis is often indicative of DIE. blue nodules in the dome (14.4%) or painful hard nodules to palpation (43.1%) are sometimes seen on pelvic triangulation, and in the case of combined chocolate cysts the masses are poorly mobile and the uterus is mostly posterior. Many doctors abroad believe that MRI is the best way to diagnose DIE, but in China the diagnosis is still difficult due to lack of experience. Intraoperative finding of disappearance of the utero-rectal trap suggests DIE in the rectovaginal compartment and also indicates anatomical abnormalities in the local area including the intestinal canal, vaginal vault, posterior cervix, ureter and large blood vessels. It is important to note that the uterosacral ligament on the side of the chocolate cyst is more likely to have DIE. Surgical excision for DIE is the primary treatment. Laparoscopic surgery has advantages over open surgery but requires good endoscopic surgical skills.DIE rarely penetrates the rectocolonic mucosa, and in most cases, lesions do not necessarily require bowel resection even if they invade the rectum and rectovaginal septum. Although the management of DIE is controversial, the majority opinion is to perform resection and anastomosis if the lesion invades the intestinal mucosa causing bleeding, pain or obstruction, otherwise partial resection of the lesion is feasible, like shaving operation, with minimal damage to the intestinal canal. For surgery of lesions in the rectal recess and vagina, in order to better identify the anatomical relationships and tissue demarcation, the patient can be examined rectally or/and vaginally with an assistant standing between the patient’s legs and lifting a rigid curved uterine device upward with one hand. If the ovaries interfere with the visual field, they can be temporarily sutured to the anterolateral abdominal wall. After seeing the normal anatomy, a dilute fluid containing vasopressin (12u dissolved in 50 ml saline) is injected into the lateral rectal fossa with a puncture needle, then the peritoneal adhesions are separated with CO2 laser and scissors, the pelvic floor fascia is opened, and the rectum is freed to enter the rectovaginal space. At this point, the lesion can be continued under the microscope, or the posterior vaginal vault can be incised under the microscope before turning to transvaginal surgery to remove the lesion. In case of intraoperative bleeding from gross vessels, bipolar electrocoagulation, vascular clips or sutures can be used to stop the bleeding. If the lesion is found to reach the intestinal mucosa after resection, the intestinal wall should be reinforced with interrupted 3/0 or 4/0 PSD sutures. In case of extensive rectal lesions, sigmoidoscopy can be performed at the same time to guide the surgeon and exclude the possibility of intestinal perforation. Before the end of the procedure, a flushing solution is injected into the utero-rectal sink, and then air is instilled into the rectum, and the utero-rectal sink is observed microscopically; if air bubbles are seen to indicate intestinal perforation, repair or bowel resection anastomosis is required. Harry Reich in the United States prefers to use a rectal loop cutting anastomosis to repair small breaches, which is simple to perform and reliable, but more costly. It is not necessary to reperitoneate the rough surface of the rectal or utero-rectal trap, as several reports have concluded that reperitoneation is unnecessary and promotes adhesion formation. Nezhat et al [19] performed such procedures in 185 women, of whom 80 had complete closure of the hystero-rectal recess, 175 patients were discharged 24 hours postoperatively after successful laparoscopic surgery, 9 had bowel perforation, and 1 had partial mesenteric resection 2-4 days postoperatively. The duration of surgery ranged from 55 to 245 minutes. 174 of the 185 cases were followed up for 1-5 years after surgery, with moderate to complete pain relief in 162 cases (93%). 13 cases (8%) required a second surgery, 4 cases required 3 surgeries, and 12 cases (7%) had persistent or worsening pain after surgery. In recent years, there has been interest in nerve-preserving complete excision of the ectopic lesion (nerve-sparing complete excision), which may reduce bladder retention and dry stools associated with nerve injury, but requires a high level of skill on the part of the surgeon. It must be emphasized that inexperienced laparoscopists, or gynecologists unfamiliar with bowel and urinary tract surgery, should not attempt to remove deep infiltrative ectopic lesions or reconstruct utero-rectal traps, as major complications may be inevitable. Most of our gynecologists lack surgical experience and are afraid or unwilling to do these surgeries However, burning, the efficacy of ectopic nodules in these areas is often poor if they are not removed, so surgical treatment of endorectal diaphragmatic ectopic disease has become an urgent problem in front of gynecologists, and it is believed that joint surgery between gynecologists and intestinal surgeons is the direction of future development. Bladder DIE is performed by focal resection or partial bladder wall resection depending on the size of the lesion. Ureteral pathology can be divided into extrinsic and intrinsic types, which occur in a ratio of approximately 4 to 1. In the former case, the ureter is compressed by the direct spread of endovascular disease in the pelvic cavity, while in the latter case, endovascular disease invades the muscular layer of the ureter and even the mucosa, causing obstruction of the lumen. Although intrinsic ureteral endothelia is rare, almost half of the patients have lost renal function by the time the diagnosis is made. Preoperative cystoscopic ureteral intubation and retention is recommended for the treatment of endoureteral ectasia, and intraoperative release of adhesions or partial ureteral resection and anastomosis is performed depending on the lesion and the degree of ureteral obstruction. If cystoscopic placement of the D-J tube fails, the patient has severe ureteral obstruction, most often intrinsic ureteral endoleaks, and surgery by a urologist is recommended. End-to-end ureteral anastomosis or ureteral bladder implantation after resection of the diseased ureter is required for these patients. DIE has become one of the urgent problems faced by gynecologists, however, due to the high risk of injury occurrence and the high technical requirements of this type of surgery, most of our gynecologists and lack of surgical experience are generally afraid or unwilling to perform these procedures. It is believed that joint surgery between gynecologists and intestinal surgeons or/and urologists is the direction of future development.