Sequential robotic and perianal approaches for excision of dual pararectal and perianal cystic lesions: A video vignette.

Abstract

To describe a sequential minimally invasive strategy for concurrent excision of dual pararectal and perianal cystic lesions. We report a case of concurrent pararectal and perianal cystic lesions excised during a single operation sequentially with two different approaches. A robotic transabdominal approach was used for the deep pararectal cyst, followed by a direct perianal approach for the superficial perianal cyst. The operative details and postoperative immediate outcomes were reported. The robotic approach provided excellent visualization and precise dissection in the deep pelvic space, while the perianal approach allowed direct access for the superficial perianal cyst. Both lesions were completely excised with uneventful postoperative recovery. Histopathology confirmed benign lesions. Sequential use of robotic and perianal approaches enables safe and complete excision of two anatomically distinct pelvic and perianal cysts in a single operation. This case underscores the importance of anatomy-based, tailored surgical planning and highlights the educational value of combining techniques for dual lesions.