title: Thoracoscopic enucleation in the left decubitus position for leiomyoma of the upper thoracic esophagus: Utility of preoperative diagnosis applying endoscopic ultrasound-guided fine needle aspiration.
abstract: BACKGROUND
  We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature.
  A submucosal tumor 45mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good.
  
  
  CONCLUSIONS
  The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation.
  
  
  CONCLUSIONS
  Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
authors.affiliation: Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki. Electronic address: mi14132104@yahoo.co.jp.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takeno
authors.affiliation: Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Division of Endoscopy, University of Miyazaki Hospital; Division of Hepato-biliary-pancreas Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.affiliation: Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki; Center for Digestive Disease, University of Miyazaki Hospital.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Division of Endoscopy, University of Miyazaki Hospital; Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki; Center for Digestive Disease, University of Miyazaki Hospital.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.affiliation: Department of Clinical Laboratory, Faculty of Medicine, University of Miyazaki.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Umekita
authors.affiliation: Department of Diagnostic Pathology, University of Miyazaki Hospital, Kihara 5200, Kiyotake-cho, Miyazaki City, Miyazaki 889-1692, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Akiyama
keywords: Case report; EUS-FNA; Esophageal leiomyoma; Thoracoscopic enucleation