This chapter describes the role of surgery in deep infiltrating endometriosis. Endometriosis is the presence of ectopic endometrium that causes scarring, infertility, and pain. It affects 6–15% of women in the reproductive age group, 20–50% women with infertility, and 71–87% of women with chronic pelvic pain. Presence of endometrial tissue 5 mm or more deep into the peritoneum is classified as deep infiltrating endometriosis (DIE). The chronic pain of endometriosis can be rivalled only by the mental agony of infertility. Management is with a balanced combination of analgesics, hormonal therapy and surgery. This chapter covers the selection of patients, preoperative counseling, principles of surgery, locating endometrial tissue, ablation versus excision, surgical steps, surgical techniques, postoperative care, outcome, surgical options for deep infiltrating endometriosis, laparoscopic-assisted bowel resection, rectal function sparing techniques, and robotic surgery.