Minimally invasive enucleation of a large, extensively calcified esophageal leiomyoma

Abstract Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. The authors report the clinical outcomes of three procedures for enucleation. Methods From November 2011 to December 2020, 3 females (52, 58, and 67 years old) patients were treated for leiomyoma of the middle third of the esophagus. A history of dysphagia and chest pain was present. Upper gastrointestinal endoscopic, computerized tomography, and endoscopic ultrasound were performed, in only one case barium swallow was used. Results The surgical approaches included right thoracoscopy in prone position, enucleation, and small thoracotomy for removing the specimen. There were no major morbidities, including deaths. One patient presented a leak, which was resolved with an endoscopic stent. Conclusion Minimally invasive enucleation of esophageal leiomyoma can be performed effectively and safely. Right thoracoscopic in prone position for the removal of esophageal leiomyomas may be recommended as the treatment of choice in centers experienced with esophageal surgery.

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Minimally invasive surgery for giant esophageal leiomyoma: a case report & review of the literatures

Journal of Thoracic Disease ◽

10.21037/jtd.2017.01.34 ◽

2017 ◽

Vol 9 (1) ◽

pp. E26-E31 ◽

Cited By ~ 5

Author(s):

Xiaosang Chen ◽

Yong Xi ◽

Hao Wang ◽

Lijie Tan

Keyword(s):

Minimally Invasive Surgery ◽

Case Report ◽

Minimally Invasive ◽

Invasive Surgery ◽

Esophageal Leiomyoma ◽

Giant Esophageal Leiomyoma

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PS01.116: EXTRAMUCOSAL ENUCLEATION IS SAFE AND FEASIBLE IN ESOPHAGEAL LEIOMYOMA IRRESPECTIVE OF SIZE: SINGLE INSTITUTION EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.116 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 82-83

Author(s):

Azhar Perwaiz ◽

Amanjeet Singh ◽

Adarsh Chaudhary

Keyword(s):

Minimally Invasive ◽

Conflicts Of Interest ◽

Benign Lesion ◽

Invasive Procedure ◽

Thoracic Esophagus ◽

Oral Contrast ◽

Esophageal Leiomyoma ◽

Large Size ◽

Duration Of Surgery ◽

The Mean

Abstract Background Esophageal leiomyoma (EL) is the most common benign lesion of esophagus. Extramucosal enucleation (EME) is the treatment of choice however esophageal resection have been favoured by some particularly when they attain large size citing risk of malignant transformation. We share our experience of EME over the last 7 years. Methods Prospectively collected database on consecutive cases of EL managed surgically between March 2010 and March 2017 were analysed retrospectively. Our department policy is to consider EME in all. Routine preoperative workup included baseline blood tests, contrast enhance computed tomography chest and upper abdomen and endoscopic ultrasound. All perioperative details were recorded prospectively. All patient underwent CT with oral contrast on day 1 of surgery to exclude leak. Final histopathology were recorded and all of them were followed 6 monthly. Results Mean age of the patients analysed (n = 21; male = 16, female = 5) were 42.7 ± 10.7 years (range 22 to 61) with mean tumor size of 8.4 ± 2.8cm (range 4.2 to 15). Commonest tumour location was thoracic esophagus (n = 16; 76.1%) followed by abdominal (n = 4; 19.2%) and cervical esophagus (n = 1; 4.7%). Most tumor were asymptomatic (n = 9/21; 42.8%) while dysphagia was commonest among those who had symptoms at presentation(7/21; 33.3%). Five (23.8%) of these were of size ≥ 10 cm (giant EL). All of them underwent EME as planned. Majority (n = 17; 81%) underwent minimally invasive enucleation (Thoracoscopic = 14, Laparoscopic = 3) while rest 4 (19%) underwent open enucleation due to large size in 1, cervical location in 1 and intolerance to minimally invasive procedure in 2. The mean operative blood loss were 72.5 ± 22 ml and none required blood transfusion. The mean duration of surgery were 122 ± 27 minutes. There were no postoperative complications that required intervention. No leak reported on postoperative day 1 scan. All patients got discharged by a mean of 5.2 ± 1.8 days. The final diagnosis were leiomyoma in all. At a mean follow up of 36 ± 17.2 months none had recurrence or any long term complication attributable to enucleation. Conclusion Extramucosal enucleation is safe in esophageal leiomyoma irrespective of size and majority of them can be managed with minimally invasive surgery. Disclosure All authors have declared no conflicts of interest.

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Robotic Fourth-Arm Enucleation of an Esophageal Leiomyoma and Review of Literature

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181c46218 ◽

2009 ◽

Vol 4 (6) ◽

pp. 354-357 ◽

Cited By ~ 6

Author(s):

Kemp H. Kernstine ◽

S. Emily ◽

Andres Falabella ◽

Natalie A. Ramirez ◽

Casandra A. Anderson ◽

...

Keyword(s):

General Practice ◽

Minimally Invasive ◽

Recovery Time ◽

Mucosal Injury ◽

Postoperative Recovery ◽

Review Of Literature ◽

Robotic Approach ◽

Esophageal Leiomyoma ◽

Robotic Technology ◽

Improve Efficiency

Esophageal leiomyomas are resected in symptomatic and/or malignancy-suspicious cases. Traditionally, they have been removed by laparotomy or thoracotomy and more recently by thoracoscopy and laparoscopy. Mucosal injury is reported as high as 7% of cases but may be higher in unreported general practice. Robotic technology seems to offer advantages. We describe a robotic approach that seems to minimize mobilization of the esophagus, potentially decreasing the likelihood of mucosal injury and postoperative recovery time. We review the literature to evaluate the reports of mucosal injury with the open, minimally invasive, and robotic techniques and describe our own method. To improve efficiency, we use a four-arm technique.

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