Esophageal Duplication Cyst -- A Guest Case in Robotic and Computer-Assisted Surgery From the University of Nebraska Medical Center

Chad Ringley, MD; Victor Bochkarev, MD; Dmitry Oleynikov, MDSeries Editors: Brant K. Oelschlager, MD; Carlos A. Pellegrini, MD

Disclosures

November 02, 2006

Surgical Techniques

Robotic-assisted transhiatal removal of the paraesophageal cyst would provide a 3-dimensional view and precise movements that allow for separation of the cyst wall, which is intimately attached to the esophagus and which prevents esophageal perforation. Robotic-assisted Heller myotomy has been shown to be superior to conventional laparoscopy in terms of esophageal perforation rate.[21]

The size and location of the esophageal duplication cysts make them amenable to laparoscopic transhiatal removal. Avoidance of esophageal perforation is important. If the cyst is more concentrated in the esophageal wall, has a common muscular layer, or has fistulous communication with the esophageal lumen, conversion to an open procedure could still be performed.

Laparotomy and thoracotomy are acceptable approaches in this setting as well. The conventional surgical approach for removal of mediastinal cysts is a posterolateral thoracotomy. One of the largest series on surgical treatment of esophageal duplication cysts in adults was reported by Cioffi and colleagues[6] in 1998. Esophageal duplication cysts should be excised by carefully preserving the muscle layer. Both vagal nerves should be identified and preserved. Mucosal integrity should be checked intraoperatively by air insufflation through the nasogastric tube.

One case in the literature described transluminal total endoscopic removal of the esophageal duplication cyst with good results.[1] However, this approach required multiple attempts and only partial cyst removal was achieved, with a residual cavity left for observation by repeated endoscopy. It is important to note that recurrence has been reported after incomplete excision of mediastinal cysts.[10]

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