The Kraske procedure (originally developed by Paul Kraske in 1884 for carcinoma of the rectum) allows access to the rectum via the presacral space in instances where the lesion cannot be addressed transanally . The most common presacral masses are developmental cysts [2-4], which histologically can be classified as epidermoid, dermoid, and enteric cysts. The latter can be subdivided into mucus-secreting and duplication cysts [3, 5].
Middle-aged females are more likely to have developmental cysts, with a 3:1 ratio when compared to their male counterparts. Although, it is estimated that about half of patients are asymptomatic, symptoms at presentation are usually associated with size (mass effect) and the presence of infections .
Differential diagnoses include cystic sacrococcygeal teratoma, perirectal abscess, presacral abscess, pilonidal disease, fistula in ano, anterior sacral meningocele, anal duct or gland cyst, necrotic rectal leiomyosarcoma, extraperitoneal adenomucinosis, cystic lymphangioma, pyogenic abscess, neurogenic cyst, and necrotic sacral chordoma [3, 5]. Complete excision is both diagnostic and therapeutic for developmental cysts .
Although the Kraske procedure has been traditionally useful for the removal of presacral lesions, more minimally invasive procedures associated with improved patient satisfaction are currently available. This study describes the surgical resection of a rectorectal duplication cyst using robotic-assisted laparoscopy.
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(Author: Stergiani Agorastos, Asha Alex, Joshua Feldman, Michael Kuncewitch, Gary Deutsch, Eric Siskind, Jeffrey Nicastro, Gene F. Coppa, Charles Conte, Mansoor Beg, Alan Kadison, John Ricci, John Hsiang-Yeou Wang, Raza Zaidi, Lynn O’Connor, Michael Nimaroff, Ernesto P. Molmenti, James D. Sullivan