Resection of esophageal diverticulum through uniportal video-assisted thoracoscopic surgery

Abstract

Open surgery remains the standard strategy for management of esophageal diverticulum in symptomatic patients. However, in the last years an increasing number of minimally invasive approaches have been proposed for this issue in order to reduce the surgical trauma and favor a fast return to daily activity. Herein, we describe a novel technique as uniportal video-assisted thoracoscopic surgery (VATS) for performing resection of esophageal diverticulum. This procedure was successfully carried out in three consecutive patients with giant mid-esophageal diverticulum (mean size: 6.5±0.5 cm). The mean post-operative time was 121±10 minutes. The chest drain was removed 48 hours later in all cases and the mean length of hospital stay was 9±1 days. No intraoperative neither postoperative complications were found in all patients but one. He had a small fistula 15 days later that was successfully treated with stent insertion. No recurrence of diverticulum was seen in all cases. Uniportal VATS is a feasible procedure that in theory could reduce the surgical trauma compared to standard open approach. However, future prospective studies should corroborate our impression before it can be recommended as acceptable therapy.

Keywords: Video-thoracoscopic; esophageal diverticulum; uniportal.

Figure 1

Gastrografin swallow (A), chest computed tomography scan (B) showed a giant mid-esophageal diverticulum. Yellow arrow shows esophageal diverticulum.

Figure 2

A 3–5-cm incision (A) was performed at level of the 7th–8th intercostal space (B) and through that a 30° camera and working instruments were inserted without rib spreading (C).

Figure 3

Dissection of mediastinal pleura over the aorta (A) and esophagus (B); complete exposition of diverticulum (C).

Figure 4

standard extramucosal myotomy (A) was performed and the diverticulum was then stapled at its base with an Endo GIA (B). Dashed line shows the neck of diverticulum.

Figure 5

Standard Belsey-Mark IV fundoplication (A). Chest drainage inserted through the uniportal incision (B).