Robotic Enucleation of Giant Esophageal Leiomyoma

Andrew Gamenthaler, MD, Ken Meredith, MD

Moffitt Cancer Center

Introduction: Traditionally the treatment of large benign esophageal lesions required the use of conventional open surgical techniques. However, recent advances in minimally invasive surgical techniques have enabled surgeons to treat a multitude of intrathoracic lesions with less associated patients morbidity by using minimally invasive techniques. Robotic surgery may be more suited for the treatment of large complex intrathoracic lesions than standard laparoscopic or thoracoscopic techniques due to the increased range of motion and 3-dimensional visualization that robotic surgery permits. We evaluate a case of a 71 year-old male with dysphagia found to have a large complex esophageal leiomyoma that underwent successful surgical resection using a minimally invasive robotic technique.

Methods: The patient was positioned in the left-lateral decubitus position and placed on single lung ventilation. The right thorax was entered at the 6th intercostals space with a 10mm trochar in a standard VATS approach and insufflated with carbon dioxide. 8mm robotic ports were placed in the 3rd and 9th intercostals spaces and one 10mm assistant’s port was placed in the 7th intercostals space. The da Vinci surgical system was then docked and the robotic hook equipped with monopolar electrocautery and the robotic atraumatic forceps were introduced. The assistant’s port was used for retraction, removal of the tumor and for suctioning. The pleura was opened and dissected free from the esophagus. An esophageal myotomy was made to expose the mass. The mass was dissected free from the esophageal mucosa and removed from the operative field with an Endo catch bag. The myotomy and the pleura were closed with a running 3-0 PDS V-lock suture. Nasogastric and thoracostomy tubes were placed and all port sites were closed with absorbable sutures.

Results: A 71 year-old male with dysphagia found to have a large complex esophageal leiomyoma of the mid esophagus underwent successful surgical resection of the tumor using a minimally invasive robotic approach. The patient underwent esophagram on postoperative day 3, which showed no evidence of leak or obstruction. The patient tolerated a regular diet on postoperative day 4 and was discharged home on postoperative day 5 with full resolution of his dysphagia. Pathology revealed completely resected 7cm x 3cm x 2cm leiomyoma.

Conclusion: The minimally invasive robotic technique can be a feasible option in situations that would have traditionally been treated with an open approach, such as resecting large complex benign esophageal lesions.

Session: Podium Presentation

Program Number: V014

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