V-09. Laparoscopic Transhiatal Enucleation of Giant Esophageal Leiomyoma: A Stepwise Technique

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ID: 325959
2026
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Ranked #140 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Esophageal Surgery Background Esophageal leiomyoma is the most prevalent benign mesenchymal tumor of the esophagus, typically arising from the muscularis propria. While minimally invasive enucleation is the preferred treatment, giant leiomyomas (>5 cm) present significant technical challenges, particularly when located in the distal thoracic esophagus near the esophagogastric junction (EGJ). This video demonstrates a stepwise laparoscopic transhiatal approach for the enucleation of a 9-cm giant leiomyoma Methods A 31-year-old asymptomatic male was incidentally diagnosed with a voluminous submucosal mass (9.0 x 5.0 cm) involving the mid-to-distal thoracic esophagus. Endoscopic ultrasound (EUS) confirmed the origin from the fourth anatomical layer, and EUS-guided fine-needle aspiration (FNA) established the diagnosis of leiomyoma. The tumor was located 3 cm proximal to the EGJ. The procedure was performed via a laparoscopic transhiatal approach. Key technical steps included: Results The operative time was uneventful with meticulous mucosal preservation despite the tumor’s size. Anti-reflux fundoplication was selectively omitted due to the tumor’s proximal location. Postoperative transient heartburn was successfully managed with short-term proton pump inhibitors. At the 1-year follow-up, surveillance endoscopy showed resolved esophagitis and no tumor recurrence. Conclusion Laparoscopic transhiatal enucleation is a safe and effective technique for giant distal esophageal leiomyomas. Precise anatomical dissection, intraoperative integrity testing, and crural repair are essential to ensure optimal oncological and functional outcomes. Video Description This video presentation demonstrates a stepwise technique for the laparoscopic transhiatal enucleation of a 9-cm giant esophageal leiomyoma. While minimally invasive enucleation is the established gold standard for benign esophageal tumors, the management of "giant" lesions (defined as >5 cm) often presents significant technical challenges regarding surgical exposure and mucosal preservation. Why this video is unique and important for the Congress: The importance of this presentation lies in demonstrating that the laparoscopic transhiatal approach is not only feasible but highly safe and effective, even for voluminous intramural masses exceeding 9 cm. Key highlights that make this video essential for surgical education include: This video provides a practical blueprint for surgeons facing large-scale esophageal submucosal tumors, emphasizing that a tailored laparoscopic approach can achieve superior oncological and functional outcomes.
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Authors Thawatchai Tullavardhana
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.409
URL
https://doi.org/10.1093/dote/doag077.409
Keywords Keywords not found

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