VM27 - Robotic Resection of Presacral Teratoma and Posterior Anal Canal Reconstruction

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Video Presentation(s)

BR

Betsy Rodriguez, DO (she/her/hers)

Surgery Resident
Memorial Hospital System
HMH- Palisades Medical Center
Dania Beach, FL, United States

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Author(s)

LQ

Luis A. Quintero, MD

Resident
Memorial Healthcare System
Plantation, Florida, United States

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Tamara V. Damrel, MD

General Surgery Resident
Memorial Healthcare System
Hollywood, FL, United States

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Natalie Ceballos, MD

General Surgery Resident
Memorial Healthcare System
Memorial Healthcare System
Pembroke Pines, FL, United States

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Hayley M. Carroll, MD

Surgical Resident
Memorial Healthcare System
Plantation, FL, United States

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Senior Author(s)

MD

Michael E. Dolberg, MD FACS FASCRS

Colorectal surgeon
Memorial Healthcare System
Davie, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Betsy Rodriguez, DO: This individual has no financial relationships with ineligible companies.

Luis A. Quintero, MD: This individual has no financial relationships with ineligible companies.

Tamara V. Damrel, MD: This individual has no financial relationships with ineligible companies.

Natalie Ceballos, MD: This individual has no financial relationships with ineligible companies.

Hayley M. Carroll, MD: This individual has no financial relationships with ineligible companies.

Michael E. Dolberg, MD FACS FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Presacral masses, or retrorectal tumors (RRT) arise from a multitude of tissues including ectodermal, neural and mesodermal components. These masses can be benign or malignant in orgin ( about 18% of the time) making management of these masses once found, challenging. We present a case of a 57 year old male with surgical history of spina bifida repair, presented with leg pain and found to have a 9x7cm presacral mass on imaging.

Methods/Interventions: Patient was evaluated with imaging and colonoscopy which did not reveal any evidence of malignancy or concern for metastatic disease Patient underwent robotically assisted resection of presacral mass, partial proctectomy and posterior anal canal reconstruction utilizing acellular matrix. Indocyanine green fluorescence angiography (ICG) was utilized to ensure adequate perfusion after resection, hemostasis and reconstruction of posterior anal wall.

Results/Outcomes: Patient’s post operative recovery was unremarkable. Final pathology is pending, however gross inspection of the mass is highly suspicious of Teratoma

Conclusion/Discussion: Presacral masses are rare tumors often encountered without a clear path of management. This case highlights a unique pathology, resection approach and reconstruction to restore normal anatomy. This case highlighted the variety of pathology that presacral masses encompass. It also presents the technical challenges which may arise from chronically inflamed masses in this area, and demonstrates innovative methods of reconstruction and restoration of normal anatomy.