Laparoscopic management in patients on peritoneal dialysis offers good postoperative outcome and early resumption to peritoneal dialysis. This is a report of a 43-year-old woman with end-stage kidney disease on peritoneal dialysis presented with left iliac fossa pain due to a large endometrioma. Emergency diagnostic laparoscopy was performed with careful laparoscopic entry, Tenckhoff catheter care and anti-adhesive application. The patient underwent temporary hemodialysis for two weeks before full resumption to peritoneal dialysis. She was planned for GnRH analogue for three months post-operatively. In conclusion, laparoscopy is a safe and advantageous route of surgery for ovarian endometrioma in patients on peritoneal dialysis. However, mindful surgical strategies are needed to ensure the Tenckhoff catheter's longevity and early resumption to peritoneal dialysis post-operatively.