Robotic, organ-preserving surgery restores kidney function and athletic career in young woman with advanced ureteric endometriosis

A powerful story of recovery and precision care is emerging for young women affected by severe and often overlooked forms of endometriosis. At Kokilaben Dhirubhai Ambani Hospital, Mumbai, a pioneering robot-assisted, organ-preserving surgery has successfully restored kidney function and enabled a young professional long jump athlete to return to competitive sport highlighting a new benchmark in the management of complex ureteric endometriosis.In India, endometriosis continues to be widely underdiagnosed, particularly when it presents outside classical gynaecological symptoms. What makes this form of endometriosis particularly dangerous is how quietly it progresses. In cases where the disease reaches the urinary tract, it can wrap around the ureter and slowly choke it off, causing obstruction, repeated infections, and eventually kidney damage that cannot be undone. The symptoms often feel like nothing more than a stubborn urinary infection, which is precisely why the diagnosis gets missed for so long and why the stakes keep rising in the meantime. This patient's journey reflects that challenge. Despite repeated urinary infections, early imaging showed a swollen kidney and dilated ureter with a small ovarian cyst. An initial laparoscopic surgery elsewhere addressed only the cyst, while the underlying ureteric obstruction remained untreated. With the obstruction continuing unaddressed, the kidney had no outlet for the pressure building inside it. By the time the full picture became clear, it had swollen to close to double its normal size, a point at which permanent functional loss becomes a very real possibility.It was only after referral to Kokilaben Dhirubhai Ambani Hospital’s Endometriosis Centre that the true extent of the disease was recognized. The centre certified by the European Endometriosis League (EuroEndoCert), the only such certified centre in India brings together gynaecologists, urologists, colorectal surgeons, radiologists, histopathologists, pain specialists, rehabilitation experts, and dieticians in a tightly coordinated, multidisciplinary model of care.“Recurrent urinary infections in young women should never be dismissed lightly,” said Dr Anshumala Kulkarni, who led the surgical team. “In this case, the infections were a warning sign of deep infiltrating endometriosis encasing the ureter. Without timely intervention, she could have lost her kidney entirely.”A robot-assisted surgery was planned with the objective of preserving the kidney and ureter. The procedure utilised Indocyanine Green (ICG) dye, which fluoresces under near-infrared imaging, allowing the surgical team to clearly visualise the ureter and perform meticulous dissection. The technology enabled the surgeons to excise the entire hard, fibrotic endometriotic nodule encasing the ureter, freeing it completely without cutting or re-implanting it a critical factor in preserving long-term organ function.What happened in the year that followed is the part of this story worth sitting with. Imaging done twelve months after surgery showed a kidney and ureter that looked entirely normal, with no trace of the obstruction that had once threatened to end both. The patient is back to training the way she did before any of this began, weightlifting, gym sessions, competitive long jump practice, and has had no further infections.In her own words, the patient shared what that journey felt like from the inside:"The second half of 2024 broke me down in ways I had never prepared for. Physically, yes, but mentally and emotionally just as much. I had spent years building a disciplined, athletic life and had no idea my body was quietly running on just 20% kidney function the entire time. The months that followed the diagnosis were a blur of hospital corridors, scan reports, and a lot of sitting with uncertainty I had no answers for. A confirmed diagnosis of severe endometriosis was what finally made sense of all of it.Dr. Anshumala Kulkarni was the person who helped me find my way back. The recovery was not linear and it was not quick, but piece by piece my strength returned. Twelve months on, I am competing again, which is something I genuinely was not sure I would be able to say.What this experience drove home for me is how easily endometriosis gets missed. Millions of women are living with it and either do not know or cannot get anyone to take it seriously. Pain that keeps coming back, fatigue that does not lift, symptoms that feel disconnected but persistent, none of that should be brushed aside. I used to push through discomfort because that is what athletes do. What I know now is that listening to your body is not weakness. It is the smartest thing you can do. The right doctors and the right diagnosis can change everything. Your hardest chapter does not have to be your last one."The bigger picture this case points to is harder to quantify but just as important. Finding this disease early, bringing the right specialists into the same room, and using technology precise enough to excise a fibrotic nodule without sacrificing the structure it has wrapped itself around that combination changes outcomes in a way that no single element of it could achieve alone. This was not just about saving a kidney. It was about giving a 23-year-old athlete her life back in full, and in doing so, it raises the bar for what complex endometriosis care in India can and should look like.