Robotic Assisted Esophagectomy for Treatment of Esophageal Hemangioma

We reported a case of primary esophageal hemangioma treated by Robotic assisted esophagectomy for video presentation. This is a 69 years old lady who presented with passage of tarry stool in December 2008. Upper endoscopy showed bluish discoloration of the mucosa with bulging from 20-25cm which occupied 2/3 of circumference of esophagus. Clinically this was suspected to be hemangioma, which was confirmed upon MRI to involve the whole thickness and circumference of the esophageal wall. Robotic assisted esophagectomy was performed with Da Vinci S system and using three arms. We started with thoracic stage and the patient was placed in left lateral position. A minithoracotomy of 6cm was opened at 5th intercostal space. The Da Vinci robot was parked at the cranial side of body. The arch of azygos was controlled with intracorporeal knotting. The esophagus distal to the hemangioma was slinged with cotton tape and retracted, while the dissection around the hemangioma was performed with diathermy scissors. The advantage of robotic assisted esophagectomy is demonstrated by the acute angulation of dissection using the robotic arm. Extraesophageal component of the hemangioma was controlled with Ligasure and harmonic scarpel. After full mobilization of the esophagus, the patient was turned to supine position and abdominal and cervical stages were preceded with open approach. The specimen was retrieved through the abdomen and gastric tube was formed. The gastric tube was delivered to the neck and esophago-gastric anastomosis was performed with hand-suture. The patient stayed in ICU for 2 days and tolerated full diet on postoperative day 10. She was discharged from hospital 2 weeks after surgery. In conclusion, esophageal hemangioma is a rare clinical condition while esophagectomy is sometimes necessary to treat large circumferential esophageal hemangioma. Robotic approach greatly enhance the performance of esophagectomy especially during the thoracic stage of dissection.

Session: Video Channel

Program Number: V072

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