Novel Use of Robotic Surgery in a Rare Case of Canal of Nuck Cyst: A Case Report and Literature Review.

Abstract

BACKGROUND A cyst within the canal of Nuck is an uncommon groin mass found in female patients. Embryologically, this is equivalent to a patent processus vaginalis in males. This cyst presents as a nonspecific bulge and is often mistaken for or presents concurrently with an inguinal hernia. Preoperative imaging assists in delineating anatomy and ruling out other differential diagnoses. Surgical management involves excision with inguinal hernia repair and has varied from open techniques to laparoscopic techniques. In this case, we describe a robot-assisted approach to cyst excision with concurrent inguinal hernia repair in an adult female patient. CASE REPORT A 42-year-old woman presented with a nonspecific mass in the left inguinal area, which was identified on magnetic resonance imaging as a fluid collection within the left inguinal canal, consistent with a canal of Nuck hydrocele. The patient underwent robot-assisted laparoscopic excision of cyst and inguinal hernia repair with mesh placement. Surgical pathology confirmed the diagnosis. CONCLUSIONS To the best of our knowledge, this is the first report of the utilization of the DaVinci robot in excision of a cyst of the canal of Nuck. Overall, the surgical approach should be determined by location of the cyst and surgeon preference. A subcutaneous cyst is easily reached via an open anterior approach. In contrast, cysts within the inguinal canal have increasingly been approached via the laparoscopic approach or a combined laparoscopic and open approach for larger cysts. We demonstrate the utility of a robotic-assisted approach to facilitate dissection, reduction, and removal of the cyst.