Endometriosis affects 10-15% of women and can result in significant deterioration in quality of life. 1-4 Deep infiltrating endometriosis (DIE) is the term used when endometrial implants, fibrosis and muscular hyperplasia are present below the peritoneum (>5 mm) and involve, in descending order of frequency, the uterosacral ligaments, the rectosigmoid colon, the vagina and the bladder. 3,5-7 It can alter the normal pelvic anatomy and be associated with significant adhesions in the pelvis which may make surgical

A nulliparous patient in her early 20s was referred to a fertility specialist for fertility preservation, before commencing chemo–radiation therapy for a recently diagnosed malignant brain tumour. Two weeks prior, she had presented with seizures and undergone emergency craniotomy and tumour resection. Taking into consideration of the tight time frame and her comorbidities, several measures were undertaken to minimise the potential increase in intracranial pressure that may lead to cerebral oedema during laparoscopy. Preoperatively, the anaesthetist administered 8 mg dexamethasone as prophylaxis. Intraoperatively, the degree of head-down tilt was minimised to 10, which was just adequate to displace bowel cranially for visualisation of pelvic structures. Finally, a shorter operative time was achieved by ensuring the most senior surgeon performed the operation, and the procedure itself was altered from the standard approach of ovarian harvesting to unilateral oophorectomy. The patient made a quick recovery and was discharged home day 1 postoperatively.