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BACKGROUND: The surgical treatment of an epiphrenic diverticulum involves resection of the diverticulum as well as a long esophageal myotomy. Although minimally invasive approaches have been used with left sided epiphrenic diverticulum, the treatment of a right sided diverticulum has required a thoracotomy. The unique capabilities of the robot, specifically three dimensional visualization and greater maneuverability in a confined space, enables a minimally invasive right sided approach to patients with a right esophageal diverticulum and single stage diverticulectomy and esophageal myotomy.
METHODS: From November 2004 until July 2011, 4 patients underwent robotic diverticulectomy and esophageal myotomy through the right chest. Success of the myotomy was judged by intra-operative EGD and post-operative esophagram. Patients were scored symptomatically both subjectively by interview and objectively by Visick classification of pre-operative and post-operative symptoms. Patients underwent rigorous follow up for recurrence of symptoms.
RESULTS: There were 3 women and 1 man. Mean age was 65.5 years. Mean operative time was 288 +/- 120 minutes. There was no gastroesophageal reflux and all patients were judged to be Visick I in the post-operative period. There was complete relief of dysphagia. There were no esophageal perforations. There was no recurrence of symptoms at a mean follow up of 12 months. Pre-operatively all patients had esophagitis. This esophagitis persisted for a mean of 6 months in 2 patients with complete resolution. Post-operatively, one patient was reintubated for respiratory failure and was diagnosed with pneumonia, and one patient underwent a laparoscopic cholecystectomy.
CONCLUSION: Robotics obviates the need for an open surgical approach in this subset of patients with right sided epiphrenic diverticulum and is associated with excellent results.