Robotic excision of a rare retrorectal cyst: Demonstration of operative strategy-A video vignette

Abstract

Retrorectal tumours represent a rare yet complex subset of pelvic masses, characterized by a wide range of differential diagnoses and nonspecific clinical presentations [1, 2]. Surgical resection is often necessary due to symptomatic presentation or concerns regarding malignancy [3]. Typically, retrorectal masses are removed using either the posterior (Kraske) or transperineal approach. However, for larger tumours with significant pelvic extension these methods may be insufficient [4]. This report discusses the case of a large retrorectal cyst successfully excised using a transabdominal robotic-assisted approach. Our patient is a-44-year-old man who presented with lower back pain. He had no bowel symptoms and unremarkable past medical and surgical histories. His physical examination was unremarkable apart from external fullness on digital rectal examination. An MRI was done for the lower back pain and incidentally showed a retrorectal cyst on the left posterior side, displacing the rectum to the right. The cyst was large, about 8 cm in size, with its upper aspect laying against vertebra S3. It showed heterogeneous content and looked inseparable from the rectal wall. It had diffusion restrictions and adherence to the levator ani muscles. Colonoscopy showed extrinsic mass compression on the rectal wall, with no mucosal abnormality. Due to a potential neoplastic process, the decision was made for cyst excision with possible rectal resection if needed intraoperatively.