The endoscopic perineal approach to the presacral space: an excision biopsy.

Presacral tumors in adulthood are rare. Several surgical difficulties exist, because of limited access of the presacral area. The patient in this report was a 72-year-old man without comorbidities referred by the urologist because of a presacral mass. Standard diagnostic evaluation disclosed no conclusive diagnosis. The perineal endoscopic approach was used to reach the presacral space. An excision biopsy, using this new technique, was performed to obtain a conclusive diagnosis. This perineal endoscopic excision biopsy was performed without complications. Postoperative pathology showed a lipoma. The patient was discharged in good health 2 days after the procedure. We concluded that this new perineal endoscopic technique is a safe, feasible approach for reaching the presacral space to resect a tumor, acquire a histologic diagnosis of an unknown tumor, or both.