title: Laparoscopic approach to retrorectal tumors: review of the literature and report of 4 cases.
abstract: BACKGROUND
  Retrorectal or presacral tumors are extremely rare and their histologic origin varies greatly. Surgical excision is indicated to prevent complications or to rule out malignancy. A laparoscopic approach has been infrequently reported to date. The aim of this article is to report our experience in 4 cases, and to review the current world experience on laparoscopic approach to retrorectal tumors.
  
  
  METHODS
  Between 1998 and 2009, we operated 4 cases in which a presacral tumor was diagnosed. A pure laparoscopic procedure was performed in 3 cases and a combined laparoscopic/transacral approach in a fourth. In addition, a systematic literature review and relevant reports on laparoscopic approach of these tumors were analyzed.
  
  
  RESULTS
  All patients underwent laparoscopic dissection of the tumor with extraction through a Phannestiel incision except in 1 case that was performed transsacrally. Simultaneously, the literature review showed 11 articles with a total number of 18 patients approached by laparoscopy.
  
  
  CONCLUSIONS
  The laparoscopic approach of retrorectal tumors is feasible. The advantages are an enhanced access and visualization of the pelvic structures and a more controlled preservation of nerve and vascular integrity. It seems to be a safe procedure and can be combined with a posterior approach if needed.
authors.affiliation: Services of Surgery, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain.
authors.forename: Franco G
authors.initials: FG
authors.lastname: Marinello
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona
authors.forename: Carlos Rodriguez-Otero
authors.initials: CR
authors.lastname: Luppi
authors.forename: Isidro
authors.initials: I
authors.lastname: Boguña
authors.forename: Joan
authors.initials: J
authors.lastname: Molet
authors.forename: Manuel
authors.initials: M
authors.lastname: Trias
mesh_terms: D000328:Adult; D003113:Colonoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*