Retroperitoneal anatomy and recto-rectal dissection of a tail gut cyst.

Jamie Murphy, BChir, PhD, FRCS1, Ahmed Akl, MD2, Johnny Yi, MD2, Megan Billow, MD2, Jacques P Heppell, MD2, Tonia M Young-Fadok, MS, MD2, Paul Magtibay, MD2. 1St. Mark’s Hospital, 2Mayo Clinic

INTRODUCTION: Tail gut cysts are rare congenital lesions that may present with per-rectal symptoms. While approximately half of all patients with these lesions are asymptomatic, tail gut cysts may become infected or rarely become the focus of malignant degeneration. Surgery is recommended to remove these lesions and laparotomy may be required to remove supra-levator cysts. Consequently, a minimally invasive approach to remove supra-levator tail gut cysts would confer significant reductions in morbidity and hospital stay. In this video we demonstrate a robotic approach that achieves these aims.

PATIENTS AND METHODS: This video demonstrates the surgical management of a patient with multiple supra-levator tail gut cysts. Following establishment of pneumoperitoneum robotic and assistant ports were placed. Rectal mobilisation was performed to the pelvic floor in the mesorectal plane. Thereafter, the mesorectum and pelvic sidewall were explored to identify tail-gut cysts, which were freed using diathermy cautery and removed using extraction bags. The patient recovered well and was discharged at postoperative day 3 without complication.

CONCLUSIONS: The use of robotic pelvic dissection to explore the mesorectum or pelvic sidewall provides a suitable minimally invasive approach for pelvic pathologies. Consequently, this approach should be considered for the management of supra-levator tailgut cysts in future.

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