What is the role of lasers in the treatment of Zenker diverticulum?

Updated: Jan 23, 2018
  • Author: Joel A Ernster, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

During the 1980s, the carbon dioxide (CO2) laser and potassium-titanyl-phosphate (KTP) laser were used to perform the incision in diverticulotomy. The CO2 laser technique remains a favored procedure in Europe and the United States. This technique is particularly useful for small (< 2 cm) and moderate (2-4 cm) diverticula because a stapler may not be able to satisfactorily grasp the "party wall" between the esophagus and diverticulum.

The risk of cervical emphysema is higher with the laser technique over the stapling technique. The laser technique, however, has a distinct advantage over the stapling technique because of the ease of transection of the "party wall." The stapler is bulky and is difficult to insert, particularly in small female patients.

A study by Kos et al of 229 endoscopic diverticulotomies (in 189 patients) indicated that using a combination of CO2 laser and AcuSpot in the endoscopic procedure provides better results than does employing endoscopic diverticulotomy with electrocautery or with a CO2 laser alone. [42] The investigators reported the following postsurgical results for the occurrence of dysphagia and repeat surgery:

Results from endoscopy with a CO2 laser were as follows:

  • Dysphagia - Absent following 78.4% of procedures

  • Repeat surgery - Required following 19.6% of procedures

Results from endoscopy with electrocautery were as follows:

  • Dysphagia - Absent following 72% of procedures

  • Repeat surgery - Required following 24.3% of procedures

Results from endoscopy with a CO2 laser and AcuSpot were as follows:

  • Dysphagia - Absent following 84.6% of procedures

  • Repeat surgery - Required following 13% of procedures

The ultrasonic scalpel is an alternate tool for transecting the “party wall” between the esophagus and diverticulum. [28]


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