This advanced laparoscopic surgery video demonstrates excision of a rectovaginal endometriotic nodule in a 31-year-old woman suffering from severe dysmenorrhea and dyspareunia due to deep infiltrating endometriosis. The case begins with MRI interpretation, followed by laparoscopic identification of uterosacral ligament disease, ovarian fixation, and posterior compartment endometriosis. The procedure highlights meticulous bilateral ureterolysis, pararectal space dissection, and development of the rectovaginal plane before excising the vaginal nodule. When residual disease is detected on repeat vaginal examination, a full-thickness vaginal excision is performed to ensure complete removal. The video concludes with vaginal reconstruction, myomectomy completion, adhesion prevention, and postoperative management. This is an excellent educational resource for surgeons managing complex posterior compartment endometriosis.