Laparoscopic Resolution of Pre Sacral Cyst by Anterior Approach

Abstract

Video Objective present an infrequent pathology of gynecological pelvic surgery, expose the clinical case and the theoretical framework in an educational way and show the surgical resolution made. Setting A 23-year-old patient consulted for adnexal blastoma in the context of previous adnexal surgery with recurrence of the image and posterior laparoscopy, without evidence of it. It provides NMR that informs, in presacral and retrorectal topography, liquid image with regular edges of 9 cm. These images were already described in 2012. Consultation is made with diagnostic imaging, who define it as voluminous extra peritoneal cystic formation at the presacral level, with thin walls and some fine septa inside, which displaces the levator ani muscle. Interventions The incidence of presacral cysts is 1 in 100,000. Generally asymptomatic. It is important the correct diagnosis and its adequate treatment; Inappropriate decision can add complications. The treatment is surgical. Depending on its characteristics, you can have previous or subsequent access. The anterior approach is indicated in tumors greater than 5 cm, superior margin beyond the 3rd sacral vertebra and inferior margin is not below the 4th sacral. In our case, the previous approach was decided, achieving the partial extirpation of the cyst with the security of recognizing the neighboring structures throughout the procedure; there were no intraoperative or subsequent complications. Conclusion In spite of its low incidence, the presacral cyst must be considered as a possible complication of a previous pelvic surgery, since the incorrect resolution brings about consequences of difficult resolution. With the appropriate evaluation and in experienced hands, the resolution in the first instance is feasible.