Design: Case report and surgical video.

Setting: Laparoscopic and robotic assisted surgery.

Patients or Participants: A patient who had a recurrent pseudocyst after hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection for stage 3C1 carcinosarcoma of the uterus.

Interventions: Laparoscopy for drainage of cyst after third recurrence, and robotic assisted de-roofing and drainage of the retropubic cyst on fourth recurrence.

Measurements and Main Results:

A 61 year old female developed a large fluid collection in the lower abdomen three weeks after a robotic assisted laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection for stage 3C1 carcinosarcoma of the uterus. The large fluid collection measured 15 x 17 x 12cm. Percutaneous drainage showed lymphocytosis and no malignant cells. After two subsequent recurrences, both of which requiring percutaneous drainage, a laparoscopic drainage of the retropubic cyst was planned on her third recurrence. There were no communicating tracts to the urachus or bladder. Omental grafts were sutured to the bilateral openings into the cyst cavity.

Less than one month after surgery, the cyst recurred, and the patient underwent a robotic assisted de-roofing and drainage of the retropubic cyst. The cyst was opened, and omental graft was sutured to the posterior edge of the cyst. Histology of the cyst wall showed infarcted fibrofatty tissue with dense fibrosis suggestive of a pseudocyst, and there were no subsequent recurrences of the pseudocyst.

Conclusion: The use of minimally invasive techniques and omental transposition grafts can be effective in the management of large abdominal or pelvic pseudocysts and avoids the morbidity of an open procedure in an already compromised patient.