Robotic Enucleation of Esophageal Leiomyoma

This video shows robotic enucleation of esophageal leiomyoma. We present the case of a 50-year-old male patient with a six-month history of increasing dysphagia. Endoscopy showed submucosal tumor growth at 25 centimeters.

Consequently, a CT skin was performed, revealing a seven-centimeter tumor in the esophagus. Histologically, a benign leiomyoma was diagnosed. Consequently, surgical therapy was indicated.

The operation started with displaying the junction of the azygos vein. The vein was ligated applying plastic clips through the assistant trocar. Then the esophagus was carefully mobilized, respecting the right vagal nerve.

After complete mobilization of the esophagus over a length of about 10 centimeters, enucleation of the lesion was started. Myotomy was performed with a monopolar cautery hook. In case of small bleeding, the bipolar forceps was used.

A formal myotomy was not necessary in principle in this case. We partially used the energy of the hook, while other steps of the procedure worked out well just by stump displacement of the muscle fibers. During enucleation, the integrity of the esophageal submucosa was respected, and stayed intact.

Traction with arm two and the bipolar forceps, assisted through the 12-millimeter port with a grasper, was carried out on demand. After complete removal of the leiomyoma, it was placed into an endo bag. Myotomy was closed using a running suture.

Afterwards, intraoperative endoscopy was performed to exclude injury of the esophageal mucosa. The postoperative course was uneventful, and the patient discharged after five days. Histological examination revealed esophageal leiomyoma.

Robot-assisted enucleation should be the gold standard for surgical treatment of esophageal leiomyoma.