title: Endoscopic repair of Zenker's diverticulum by harmonic scalpel.
abstract: OBJECTIVE
  Although endoscopic staple-assisted esophagodiverticulostomy (ESED) has become the initial treatment of choice for most patients with Zenker's diverticulum (ZD), anatomical restraints prevent its use in all cases. We describe an endoscopic approach for treating ZD using the harmonic scalpel, which can be used in certain cases where diverticulum anatomy precludes ESED.
  
  
  METHODS
  Medical records of 7 consecutive patients who underwent endoscopic repair of ZD using the harmonic scalpel (Harmonic Ace, Ethicon Endo-Surgery, Inc, Cincinnati, OH) were reviewed. Data collected included demographics, symptoms, surgical details, complications, and postoperative outcomes. Main outcome measures were time to resumption of oral diet, symptom resolution, and complications.
  
  
  RESULTS
  All patients (N = 7) who underwent endoscopic repair of ZD using the harmonic scalpel resumed an oral diet at initial follow-up visit after surgery (mean, 7 days; range, 4-9 days) and rated their symptoms as being completely resolved at subsequent follow-up (mean, 4 months; range, 1.5-8 months). There were no complications.
  
  
  CONCLUSIONS
  Endoscopic repair of ZD using the ultrasonic cutting shears is a safe and efficacious procedure that allows for endoscopic treatment in certain cases that cannot be treated by ESED. Further study is warranted in larger series to determine efficacy and safety compared with established endoscopic techniques.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, FL, USA. jmay@health.usf.edu
authors.forename: James T
authors.initials: JT
authors.lastname: May
authors.forename: Tapan A
authors.initials: TA
authors.lastname: Padhya
authors.forename: Thomas V
authors.initials: TV
authors.lastname: McCaffrey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000295:instrumentation* / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D016672:Zenker Diverticulum / Q000175:diagnosis / Q000601:surgery*