Introduction: This video discusses the surgical technique of a robotic-assisted laparoscopic left vesiculectomy and distal left uretectomy for a 25-year-old male patient found to have Zinner Syndrome. Zinner Syndrome is a rare syndrome first described in 1914 as a congenital mesonephric duct malformation. Since its discovery, only approximately 200 cases have been described in the literature. Historically, the only surgical options for a vesiculectomy were an open approach via transabdominal or transperineal. Currently, laparoscopic, and robotic assisted surgery may be considered as these minimally invasive techniques offer reduced blood loss, shorter hospital stays, and faster recovery. In this video, we present the robotic approach for a left vesiculectomy and distal left ureterectomy in a young patient plagued by perineal discomfort.
Methods: The patient is a 25-year-old male who presented to his urologist with a one-year history of pelvic and perineal pain. On further workup, he was found to have left renal agenesis but otherwise normal renal function. His constellation of symptoms along with his exam and imaging findings were consistent with Zinner Syndrome. After discussing options, the patient elected for surgical excision of the seminal vesicle cyst for symptom management.
This surgical video demonstrates a robotic-assisted laparoscopic approach to the removal of the left seminal vesicle cyst and ectopic ureteral remnant. The surgery was approached by incising the posterior peritoneum while lifting the bladder to identify the multiloculated left seminal vesicle cyst. In this video, one can appreciate the massive size of this complex cyst. The cyst was carefully dissected to preserve the right seminal vesicle and vas deferens as they were anatomically normal.
Results: The patient was discharged home the same day without a drain. We left a Foley catheter for 9 days and passed his voiding trial at his follow-up appointment. On further follow-up, the patient’s symptoms have completely resolved, and his ejaculatory volume has remained unchanged.
Conclusions: This video showcases the rare urogenital anomaly of Zinner syndrome. The patient’s uncomplicated post-operative course and full resolution of symptoms highlight the advantages of this minimally invasive robotic approach as a viable and effective treatment option for symptomatic patients with this condition. Furthermore, although Zinner syndrome is rare, it should be considered in the differential diagnosis of cystic masses within the male pelvis.