Resection of a Large Cyst in the Retroperitoneal Space Using Natural Orifice Transluminal Endoscopic Surgery

Excerpt

A 60-year-old woman presented with upper abdominal distention that persisted for 1 year. The abdominopelvic computed tomography scan revealed a large cystic mass (104 × 97 mm) originating near the pancreatic tail (Fig. 1). Surgery was proposed due to the potential malignant and symptomatic nature, but she refused. Thus, natural orifice transluminal endoscopic surgery (NOTES) was performed. A transgastric access was created. The cystic lesion was carefully dissected and the cystic wall was incised to drain the fluid to ensure en bloc resection. During the procedure, multiple snares were used as traction to expand the visual field and expose the margin of the mass (Fig. 2). After the lesion was removed completely, hemostasis was achieved with hot biopsy forceps and delayed bleeding was prevented. The gastric defect was closed using the kissing suture method. The patient recovered uneventfully and has been doing well for the past 3 months. The histological report showed the resected specimen was multilocular and that the cyst lining was a simple epithelium covering, which was consistent with an epithelial cyst.

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