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Video

Session:: Ongoing Videos

V63 - Robotic Excision of Large Presacral Cyst With Perineal Extension: Overcoming Technical Challenges With Enhanced Reach and Precision

Saturday, May 9, 2026
On-Demand

    Video Presentation(s)

  • Nikita Wadhwani, MD (she/her/hers)

    Colon and rectal surgery fellow
    The Ohio State University
    University of Alabama at Birmingham
    Columbus, OH, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    • Author(s)

  • KP

    Kent Peterson, MD

    Assistant Professor
    Sanford Heath
    Fargo, North Dakota, United States

    Disclosure information not submitted.

  • JC Chen, MD MPH (they/them/theirs)

    Resident
    Ohio State University
    Ohio State University
    Columbus, OH, United States

    Disclosure information not submitted.

  • Michelle Chan, MD (she/her/hers)

    General surgery resident
    The Ohio State University
    The Ohio State University
    Columbus, OH, United States

    Disclosure information not submitted.

  • Joy Zhang, MD

    General Surgery Resident
    The Ohio State University Wexner Medical Center - Columbus, OH
    Columbus, OH, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

  • SB

    Sydney C. Beache, MD, MPHS (she/her/hers)

    Fellow
    The Ohio State University
    The Ohio State University
    Columbus, OH, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

  • Melik Kagan Aktas, MD (he/him/his)

    Postdoctoral Clinical Research Fellow
    The Ohio State University Department of Surgery
    The Ohio State University
    Columbus, OH, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    • Senior Author(s)

  • Syed Husain, MB.,BS.

    Professor of Surgery-Clinical
    The Ohio State University
    Ohio State University
    Columbus, Ohio, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

CME Eligible

Purpose/Background: Presacral cysts often present challenging surgical anatomy necessitating complex approaches for complete excision. Traditionally, open or combined abdominal-perineal techniques have been employed, associated with increased morbidity, wound complications, and prolonged recovery. Robotic-assisted surgery enhances precision, visualization, and the ability to perform deep pelvic dissection, which may obviate the need for a separate perineal incision, thereby reducing operative morbidity. Here, we present a case of a large presacral cyst with infralevator extension successfully managed via a robotic transabdominal approach

Methods/Interventions: 44-year-old woman with a history of endometriosis presented with episodic constipation, rectal spasms, and cyclical rectal bleeding associated with lower abdominal discomfort. On examination, she had fluctuance along the posterior perianal region. Flexible sigmoidoscopy revealed extrinsic stenosis of the lower rectum with no mucosal abnormality. Surgical planning included robotic excision with possible conversion to combined abdominoperineal approach and coccygectomy if indicated.

Results/Outcomes: Intraoperatively, a complete robotic transabdominal dissection was achieved, enabling separation of the cyst from the pelvic floor and ischiorectal fossa. The procedure was completed entirely transabdominally, without the need for a perineal incision or coccygectomy. The pelvic floor defect was repaired robotically. The patient's postoperative course was notable for constipation, attributed to transient pelvic floor dysfunction, and managed effectively with laxatives. She experienced progressive improvement in bowel function during follow-up as postoperative inflammation resolved.

Conclusion/Discussion: Excision of presacral cysts with infralevator extension is optimally achieved with robotic assistance, as it provides enhanced access and precision for complex pelvic dissections. This approach enables meticulous cyst excision and pelvic floor repair without the morbidity associated with a perineal incision. Consequently, robotic surgery may reduce perioperative complications and facilitate faster postoperative recovery in patients with challenging pelvic anatomy.