Presacral tumors are rarely found in adults. Resections via open abdominal or sacral approaches have been advocated traditionally as the preferred treatment for these tumors. The endoscopic surgical technique provides direct visualization of the presacral or retroperitoneal space. The authors report on a 67-year-old man who experienced difficulty in defecation off and on for 5 weeks, and recently he had suffered indistinct pain in the lower abdomen. The abdominal computed tomography scan revealed a 5.1 x 4.2-cm, homogeneous, low-density, well-defined mass arising from the left sciatic nerve abutting the left piriformis muscle, favoring a diagnosis of benign neurogenic tumor. Endoscopically guided resection was applied, with a favorable outcome. This procedure represents a less invasive approach that may be useful for benign retroperitoneal pelvic tumors.