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 of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

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.
JZ

Joy Zhang, MD

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

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SB

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

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

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
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 of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Syed Husain, MB.,BS.

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

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Nikita Wadhwani, MD: This individual has no financial relationships with ineligible companies.

Joy Zhang, MD: This individual has no financial relationships with ineligible companies.

Sydney C. Beache, MD, MPHS: This individual has no financial relationships with ineligible companies.

Melik Kagan Aktas, MD: This individual has no financial relationships with ineligible companies.

Syed Husain, MB.,BS.: This individual has no financial relationships with ineligible companies.

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.