Sphincter-Preserving Robotic Excision of a Pararectal Mass

Abstract

Purpose:

To demonstrate sphincter-preserving robotic excision of a pararectal mass.

Materials and Methods:

This video illustrates how to remove a pelvic mass through an intracorporeal approach sparing any damage to the anal sphincter muscles. The patient was a 15-year-old girl who came to her OBGYN with left abdominal pain, flank pain, and sensation of incomplete emptying of the rectum. There was a clear homogeneous pelvic mass impinging on the rectum found on CT and MRI. Therefore, surgery was planned to remove the mass. Under general anesthesia, the patient was placed in a supine lithotomy position. A 12-mm trocar was inserted, and the abdomen was insufflated. Next, under direct vision, two additional 8 mm trocars were inserted at the level of the umbilicus on the lateral abdomen. The uterus was suspended with a 0 Vicryl suture to provide retraction. The left fallopian tube was also suspended for enhanced observation. The assistant port was then placed in the right upper quadrant and the robot was docked. Dissection was then begun on the left side of the rectum up to the pelvic diaphragm and was continued deeper left and laterally to the rectum, where the mass was identified and dissected free. The mass was removed, and the perirectal space was irrigated. Hemostasis was confirmed, and the left peritoneal reflection was closed using 0 Vicryl suture. Abdomen was then again inspected, and hemostasis was deemed satisfactory.

Results:

The result was no damage to the anal sphincters on examination postoperatively. ^{1 , 2} We removed the entire mass, and the patient no longer reports sensation of inadequate emptying. ³ She continues to have continence.

Conclusion:

This video showed a unique removal of a pelvic mass that spared damage to surrounding structures. The patient followed up with her primary care physician 3 months after surgery, and the incision was healed. ¹ Rectal examination showed no masses, and the patient regained sensation of stool evacuation. Cytology showed a benign pelvic dermoid cyst.

This video demonstrates sphincter-preserving robotic excision of a pararectal mass.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

No competing financial interests exist.

Runtime of video: 7 min 26 secs

This video has been presented at the Pacific Association of Pediatric Surgeon on April 2020 annual meeting but has not been published elsewhere, accepted for publication, or under editorial review for publication elsewhere; and all the authors involved are fully aware of this submission.