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International Society For Minimally Invasive Cardiothoracic Surgery

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Transhiatal Robotic Esophageal Epiphrenic Diverticulectomy, Heller Myotomy, Lateral Fundoplication, And Cruroplasty
Romulo Fajardo1, Abbas Abbas1, Roman Petrov1, Charles Bakhos2
1Temple University Hospital, philadelphia, PA, USA, 2Temple University Hospital, Philadelphia, PA, USA

V01: Transhiatal Robotic Esophageal Epiphrenic Diverticulectomy, Heller Myotomy, Lateral Fundoplication, and Cruroplasty
Background: The aim of this study is to present the surgical technique and results of treatment of a symptomatic patient with a large intrathoracic esophageal epiphrenic diverticulum through the abdomen.
Methods: The patient is a 68-year-old male with severe dysphagia, regurgitation, and halitosis. Patient underwent preoperative testing which included a CT scan, high resolution manometry, upper GI x-rays, and esophagogastroduodenoscopy. CT scan and abdominal x-rays showed a large 5.1 cm x 5.2 cm intrathoracic epiphrenic diverticulum. Esophageal manometry showed appropriate relaxation of the lower esophageal sphincter, abnormal peristalsis, 0% bolus clearance, IRP: 29.4 mmHg, Resting pressure: 11 mmHg, DCI mean: 753.7 mmHg-cm-s, and no hiatal hernia. Due to his severe symptoms, the patient underwent a transhiatal robotic esophageal epiphrenic diverticulectomy, Heller myotomy, lateral fundoplication, and cruroplasty.
Results: The procedure was performed entirely transhiatal in the abdomen. A 10 cm long myotomy and lateral fundoplication were achieved after full mobilization of the intrathoracic diverticulum into the abdomen for the diverticulectomy. Upper GI the following day was negative for any leak, contrast extravasation, or obstruction. Patient was discharged from the hospital postoperative day 2 tolerating a soft diet. At 7 months follow up, the patient has no dysphagia, halitosis, or heartburn.
Conclusions: Transhiatal robotic assisted laparoscopic esophageal epiphrenic diverticulectomy for a large intrathoracic diverticulum is safe and feasible. In comparison to the transthoracic approach, a transabdominal approach provides adequate exposure for a long enough myotomy in addition to offering various options for simultaneous fundoplication.


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