Robotic management of a large mullerian duct cyst: a case report and review of surgical options

INTRODUCTION: Mullerian duct cysts (MDCs) are a rare diagnosis in adulthood, primarily found in men aged 20 to 40 due to reproductive or urinary symptoms. Asymptomatic patients are generally observed. Treatment of symptomatic patients varies widely based on the presentation. Small cysts can be treated with transurethral and percutaneous methods due to a lower risk of damage to surrounding structures. However, larger and more complicated cysts are often treated using open or laparoscopic approaches. CASE DESCRIPTION: Our case presents a 38-year-old male with worsening obstructive lower urinary tract symptoms and recurrent episodes of acute urinary retention. Preliminary diagnosis of a MDC was made using CT and MRI. After failing initial minimally invasive therapy, the patient was treated with definitive robotic-assisted laparoscopic surgical excision of the cyst. At the one-month follow-up, the patient reported no complications and resolution of symptoms. As shown by this case, robotic surgical methods may be used as a more precise approach, reducing the risk of damage to vessels, nerves, and structures within the abdomen and pelvis. CONCLUSIONS: Asymptomatic patients can be observed. Treatment of symptomatic patients varies widely based on the presentation. Small cysts can be treated with transurethral and percutaneous methods due to a lower risk of damage to surrounding structures. Larger, more complicated cysts are often treated using open, laparoscopic, or robotic surgical methods. More precise approaches, including robotic methods, can reduce the risk of damage to vessels, nerves, and structures within the abdomen and pelvis.