Robot-assisted thoracic resection of an extended esophageal leiomyoma
Epublication WebSurg.com, May 2015;15(05). URL: http://websurg.com/doi/vd01en4481
Objective: Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors. Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion. Case presentation: We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis. In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma. Conclusion: Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.