Difficult Retrorectal Cyst Robotic Platform

Ahmed Al-Khamis, MD, FRCSC; Elizabeth Arcila, MD; Kunal Kochar, MD; John J. Park, MD, FACS, FASCRS; Slawomir J. Marecik, MD, FACS

Product Details
Product ID: ACS-5534
Year Produced: 2018
Length: 4 min.


This is a video of a difficult case of retrorectal cyst excision. The patient was a 31-year-old female who had a history of a remotely infected retrorectal cyst that was managed with a CT guided drainage at an outside hospital. As expected, the cyst persisted. On digital rectal exam the cyst was barely palpable and the colonoscopy was normal. Preoperative imaging revealed no communication with the gastrointestinal tract and the cyst appeared to be located in vicinity of the mid-lower rectum. It was about 8cm in size and was very closely adherent to the left lateral/anterior portion of the rectum, the left pelvic plexus, the left piriformis muscle and the levators. Using the robotic platform, we started with posterior mobilization of the rectum as we did not expect sacral involvement. Starting posteriorly in a virgin plane allowed us to find the anatomical landmarks, and understand better the cyst relationship to surrounding structures. We found the cyst to be intimately associated with the mesorectum, abutting and stretching the left lateral compartment and the vagina and its mass affect causing attenuation of the left lateral and central aspects of the levators. During the most critical part of the dissection, dissecting the plane between the cyst and the rectal wall, we found using flexible sigmoidoscopy to periodically distend and collapse the rectum extremely helpful. We were able to excise the whole cyst wall with preservation of surrounding organs. We had no peri-operative morbidity. The patient was discharged home the following day.