Abstract
Introduction:
Primary retroperitoneal cysts are rare, often benign lesions that are typically discovered incidentally during imaging for unrelated conditions. 1 Their indolent growth and nonspecific presentation can delay the diagnosis. Surgical excision remains the treatment of choice. 2,3 Laparoscopic approach offers the benefits of minimal invasiveness, though large cysts pose a risk of intraoperative rupture and spillage. 4,5 This case highlights a novel trocar technique for safe laparoscopic excision of a large retroperitoneal cyst.
Materials and Methods:
We report the case of a 33-year-old female who presented with dull, intermittent right-sided abdominal pain for 2-months. Imaging revealed a large (15 × 7 × 7 cm), thin-walled, unilocular cyst in the right retroperitoneum, separate from adjacent organs and displacing bowel loops medially. It was approached laparoscopically, and controlled decompression of the cyst was performed using a serrated 5-mm bariatric trocar. Cyst contents were aspirated, and the decompressed cyst was circumferentially dissected and retrieved in an Endo BagTM.
Results:
The use of a long-serrated trocar allowed controlled aspiration of the cystic contents without spillage. The cyst was excised in its entirety with clear planes and without damage to adjacent structures, including the ureter and bowel. The patient had an uneventful postoperative recovery, with drain removal on postoperative day (POD) 2 and discharge on POD 3. Histopathology confirmed a benign primary retroperitoneal mucinous cystadenoma. At 6-month follow-up, the patient remained asymptomatic with no evidence of recurrence.
Conclusion:
Laparoscopic management of large retroperitoneal cysts is feasible and safe. The adoption of a trocar system provides direct, sealed access into the cyst without any spillage. This facilitates controlled decompression and also aids in the complete excision of the cyst.
The corresponding author has received and archieved patient consent for video recording/publication of the video without exhibiting patient demographic details in advance.
This is an original work carried out in a tertiary care public hospital, and there are no conflicts of interest or obligations resulting from it to any of the authors.
There are no commercial associations during the last 3 years that might create a conflict of interest in connection with the video. The corresponding author has received and archived patient consent for video recording/publication in advance of video recording of the procedure.
Runtime of video:
7 mins 47 secs