We present a combined robotic-assisted abdominal and sacral approach for excision of a large presacral cyst in a 37 year old woman who presented with several years of pelvic and right buttock pain. A Davinci Xi Robot was utilized for the abdominal portion. The large presacral cyst was dissected circumferentially from the vagina, rectum and pelvic floor. The patient was then flipped into the prone position where a curvilinear incision over right buttock was made. The cyst was found in the right lateral area next to the coccyx. The cyst was excised in whole and a coxxygectomy was performed. The defect was filled with a locoregional gluteus muscle flap by plastic surgery.