Single-port Video Assisted Thoracoscopic Surgery For A Huge Epiphrenic Esophageal Diverticulum
Do Kyun Kang, Ji Yong Kim, Ho-ki Min, Hee Jae Jun, Youn-Ho Hwang.
Haeundae Paik Hospital, Busan, Korea, Republic of.
OBJECTIVE: Recently, many surgeons have attempted minimally invasive surgeries for epiphrenic esophageal diverticula. They reported that minimally invasive surgery for epiphrenic esophageal diverticula was a safe and feasible approach which had many advantages. There are various options of surgical approaches for minimally invasive surgery of epiphrenic diverticula. However, the best surgical approach remains uncertain. We report the case of a huge epiphrenic esophageal diverticulum, which was successfully treated by single-port video-assisted thoracoscopic surgery.
METHODS: The patient who was diagnosed with a huge ephiphrenic diverticulum(6.7x5.1cm) underwent video-assisted thoracosopic surgery through about 4cm sized single incision. The incision was made in the left 6th intercostal space on the mid-axillary line. An X-small-sized wound retractor was applied for securing the intercostal space and 5mm-30° thoracoscope was used. The diverticulum was dissected away from the pleura and adherent muscle fiber avoiding mucosal perforation into the lumen with 5mm-endoscopic grasper, spatula-shaped electrocautery, and 5mm-endoscopic ultrasonic scalpel. The entire diverticular neck was exposed and divided with an endoscopic linear stapler. The overlying muscle layers were reapproximated over the stapler line by interrupted suture with 3-0 black silk. A myotomy was performed on the contralateral side of the stapler line from the upper level of the diverticulum to the upper level of the lower esophageal sphincter. The myotomy was not extended onto the LES. The incised mediastinal pleura was closed by interrupted suture.
RESULTS: The operation time was 155 minutes. The patient was maintained fasting for 6 days after the surgery. On the 6th day after the surgery, an esophagogram with gastrografin was performed, which revealed that there was no stapler line leak and stenosis. The patient resumed an oral diet 7 days after the surgery. The patient was discharged on postoperative day 8 without symptoms of dysphagia and regurgitation. The patient was followed up without recurrent disease for six months.
CONCLUSIONS: Single-port VATS could be a useful option among various surgical approaches for epiphrenic esophageal diverticula in well selected patients.
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