title: Robotic-assisted enucleation of a large lower esophageal leiomyoma and review of literature.
abstract: Leiomyoma is the most common benign esophageal neoplasm. Different invasive surgical approaches have been described for management of such lesions. The literature is reviewed and a robotic assisted left thoracoscopic enucleation with the patient in the right side position is described. A 40-year-old male patient, otherwise healthy, found to have a lower midiastinal mass on screening X-ray, is described. Physical examination and blood tests were within normal limits. Diagnostic work-up included: computerized tomography (CT) scanning of the chest and midiastinum that revealed a 40 × 30 mm mass of the distal esophagus, an upper gastrointestinal endoscopy showed a lower protruding esophageal submucosal mass with intact mucosa, a filling defect was apparent on esophagography. Endoscopic ultrasonography (EUS) showed the same findings, biopsies were taken and leimyoma was diagnosed. Under general anesthesia with a double-lumen endotracheal tube, the patient was positioned on his right side. A 30 robotic scope was introduced in the left 7th intercostal space on the posterior axillary line. Two 8-mm robotic trocars were inserted in the left 5th and 9th intercostals spaces on the same line. Operative field was clearly exposed and an additional 5-mm ethicon trocar was inserted. The inferior pulmonary ligament was released, the parietal pleural space opened, proximal and distal control was achieved using Penrose. The muscular layer of the lower esophagus was opened by coagulation hook, the lesion was enucleated without mucosal penetration. Intraoperative endoscopy permitted localization of the lesion and ensured mucosal integrity. The muscular layer was not closed and the chest drain was left. Total operative time was 200 min and blood loss was less than 20 mL. A Gastrograffin swallow on the first post-operative day showed good esophageal clearance and absence of leak, the patient was allowed a liquid diet. He was discharged on the third post-operative day in a good general condition, benign pathology was confirmed.
authors: Hadassah Hebrew University Medical Center - General Surgery, PO Box 12000, Jerusalem, 91120, Israel.
authors: Abed
authors: A
authors: Khalaileh
authors: Ira
authors: I
authors: Savetsky
authors: Mohamed
authors: M
authors: Adileh
authors: Ram
authors: R
authors: Elazary
authors: Mahmoud
authors: M
authors: Abu-Gazala
authors: Samir
authors: S
authors: Abu Gazala
authors: Samir Abu
authors: SA
authors: Gazala
authors: Avi
authors: A
authors: Schlager
authors: Avraham
authors: A
authors: Rivkind
authors: Yoav
authors: Y
authors: Mintz
mesh_terms: D000328:Adult; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D011859:Radiography; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods
keywords: benign esophageal tumors; enucleation; esophageal leiomyoma; minimally invasive surgery; robotic