Video-assisted thoracoscopic surgery for large Zenker's diverticulum: report of two cases.
BACKGROUND
Zenker's diverticulum is a propulsion diverticulum in the pharynx. Current practice for the management of symptomatic pharyngeal pouches includes endoscopic pharyngeal stapling, performed trans-orally, and external approaches via a cervical incision. There is no published recommendation on how to approach diverticula with extension into the mediastinum, which may not be adequately treated with the above methods.


METHODS
We describe two cases in which thoracoscopic mobilisation of Zenker's diverticulum was performed using video-assisted thoracoscopic surgery together with traditional transcervical mobilisation and excision of the pouch. This allowed safe surgical access to the inferior limit of the pouch, and delivery of the sac into the neck incision following division of any inferior adhesions (to the great vessels in one case).


CONCLUSIONS
In the first report of this technique, we describe a thorough, safe method of dissecting large diverticula that extend into the mediastinum, which minimises the risk to mediastinal structures.
Department of ENT, Royal Surrey County Hospital, Guildford, UK.
A
A
Hay
Oesophagogastric Unit, Royal Surrey County Hospital, Guildford, UK.
B A
BA
Ozdemir
Oesophagogastric Unit, Royal Surrey County Hospital, Guildford, UK.
Y
Y
Soon
Department of ENT, Royal Surrey County Hospital, Guildford, UK.
L
L
Pitkin
D000328:Adult; D000368:Aged; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016672:Zenker Diverticulum / Q000000981:diagnostic imaging / Q000601:surgery*