Abstract
Clinical History:
A 25-year-old man presented with a 1-year history of pelvic and perineal pain. On further work-up, he was found to have left renal agenesis but otherwise normal renal function. Magnetic resonance imaging revealed an enlarged and multiloculated left seminal vesicle complex. His constellation of symptoms along with his examination and imaging findings was consistent with Zinner syndrome. After discussing options, the patient elected for surgical excision of the seminal vesicle cyst for symptom management.
Intervention:
This video demonstrates a robot-assisted laparoscopic approach to the removal of the left seminal vesicle cyst and ectopic ureteral remnant. The surgery was approached by incising the posterior peritoneum while lifting the bladder to identify the multiloculated left seminal vesicle cyst. In this video, one can appreciate the massive size of this complex cyst. The cyst was carefully dissected to preserve the anatomically normal right seminal vesicle and vas deferens. The ureteral remnant ectopically inserted into the seminal vesicle cyst and was dissected proximally to remove the entire ureteral remnant. The cyst wall was noted to be adherent to the bladder wall with invasion into the detrusor muscle. As such, cystorrhaphy was performed to make sure the entire cyst was removed. We then closed the peritoneal flap to re-retroperitonealize the space.
Follow-Up:
The patient was discharged the same day without a drain. On follow-up, the patient's symptoms completely resolved, and his ejaculatory volume has remained unchanged. Final surgical pathology analysis revealed a benign complex seminal vesicle cyst and distal left ureter.
No competing financial interests exist.
Runtime of video: 4 mins 59 secs
Consent:
Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Music: Underwater Cavern by Purrple Cat |
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