Robot-assisted laparoscopic radical prostatectomy en bloc with a large Müllerian duct cyst

Background: Müllerian duct cysts (MDCs) are often incidental findings located on the dorsal aspect of the prostate. When large, they can present with significant surgical challenges, particularly in cases requiring radical prostatectomy for concurrent malignancy. We present a case of robot-assisted laparoscopic radical prostatectomy (RARP) performed en bloc with a large MDC, highlighting the surgical approach and its clinical implications. Case presentation: A 64-year-old man presented with an elevated prostate-specific antigen (PSA) level of 21.763 ng/mL. He reported no lower urinary tract symptoms. Magnetic resonance imaging revealed a 26-mL prostate without suspicious lesions; however, a 37-mm mid-dorsal cyst was identified. Transperineal prostate biopsy revealed adenocarcinoma, ISUP grade group 3 (Gleason score 4+3), located in the anterior prostate. The patient underwent a bilateral-nerve sparing RARP en bloc with an MDC for the treatment of cT1cN0M0 prostate cancer. The total procedure time was 235 min, with a console time of 180 min and a blood loss of 300 mL. There were no perioperative complications. Final pathology reported a T2c, ISUP grade group 4 (Gleason score 4+4) prostate adenocarcinoma and confirmed the presence of an MDC. Conclusions: This case represents the first reported instance of RARP en bloc with a large MDC and the second case of RARP for prostate cancer with a large MDC in the literature. Our video illustrates that en bloc RARP with a large MDC is both safe and feasible, while providing a distinctive intraoperative view.