Laparoscopic resection of a large primary retroperitoneal mucinous cystadenoma assisted by controlled decompression with a SAND balloon catheter: a case report

Introduction and importance: Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare epithelial neoplasm that is challenging to diagnose preoperatively because of nonspecific imaging findings. Laparoscopic resection of large retroperitoneal cystic tumors can be technically demanding because of limited working space and the risk of cyst rupture and fluid spillage. Case presentation: A 43-year-old woman presented with a gradually enlarging palpable mass in the left lower abdomen. Contrast-enhanced computed tomography revealed a well-defined, unilocular cystic lesion measuring 12 × 10 × 7 cm, without enhancing solid components or adjacent organ invasion. Laparoscopic resection was performed with controlled decompression using a SAND balloon catheter. Approximately 450 mL of cyst fluid was aspirated, thereby facilitating operative visualization. Complete resection was achieved without intraoperative spillage. Histopathological examination confirmed a benign PRMC. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. At 7 months, she remained well, without recurrence. Clinical discussion: In this case, the absence of radiological features strongly suggestive of malignancy supported a laparoscopic approach, while the large cyst markedly restricted the working space and made intact manipulation difficult. Although intact excision is preferable, controlled decompression may be considered a selective technical adjunct in such circumstances. Conclusion: PRMC is a rare cystic neoplasm, and laparoscopic resection of large lesions can be technically challenging. In the present case, controlled decompression using a SAND balloon catheter facilitated laparoscopic resection and may represent a useful technical option when intact excision is difficult.