V-04. Robotic-Assisted Thoracoscopic Enucleation of Esophageal Leiomyoma

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ID: 325974
2026
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Ranked #94 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 common benign esophageal tumor. Surgical enucleation is indicated for symptomatic or large lesions to relieve symptoms and prevent complications. Although minimally invasive approaches have reduced postoperative morbidity, enucleation of large encapsulated tumors remains technically demanding, particularly in preserving mucosal integrity and adjacent structures. Robotic-assisted surgery enhances three-dimensional visualization and instrument articulation, enabling meticulous surgical dissection and facilitating complex maneuvers within confined mediastinal spaces, thereby allowing safe tumor removal while maintaining mucosal preservation. Methods A robotic-assisted thoracoscopic enucleation was performed in a patient with a large esophageal leiomyoma. The patient was positioned in a left lateral semi-prone position. After port placement, the mediastinal pleura overlying the tumor was incised, and the esophagus was circumferentially mobilized. A longitudinal esophageal myotomy was created to expose the tumor capsule. Using articulated robotic instruments, meticulous blunt and sharp dissection was performed circumferentially along the submucosal plane while preserving the mucosa. Intraoperative endoscopy confirmed mucosal integrity. Following complete enucleation, the muscular layer was re-approximated with interrupted sutures. The specimen was retrieved in an endoscopic bag, and a chest drain was placed at the completion of the procedure. Results Complete tumor enucleation was achieved without mucosal injury. The robotic platform provided magnified three-dimensional visualization and wristed instrumentation, enabling precise dissection along the tumor capsule. Operative time was acceptable, and estimated blood loss was minimal. The postoperative course was uneventful. Oral intake resumed after confirmation of esophageal integrity. Histopathological examination confirmed an 8.5-cm leiomyoma with negative margins. No postoperative complications, including esophageal leak, were observed. Conclusion Robotic-assisted thoracoscopic enucleation is a safe and effective minimally invasive approach for esophageal leiomyoma. Enhanced visualization and superior instrument articulation facilitate meticulous dissection and reliable preservation of mucosal integrity, particularly in large tumors. This technique may improve surgical precision and optimize perioperative outcomes in carefully selected patients with benign esophageal tumors. Video Description This video demonstrates a step-by-step robotic-assisted thoracoscopic enucleation of a large esophageal leiomyoma. Key procedural steps—including patient positioning in the left semi-prone position, strategic port placement, mediastinal pleural incision, and circumferential mobilization of the esophagus—are clearly illustrated. A longitudinal myotomy exposes the tumor capsule, followed by meticulous blunt and sharp dissection along the submucosal plane using articulated robotic instruments. Particular emphasis is placed on technical strategies to prevent mucosal injury during circumferential enucleation. The advantages of magnified three-dimensional visualization and wristed instrumentation in confined mediastinal spaces are highlighted. Intraoperative endoscopic assessment of mucosal integrity and reconstruction of the muscular layer with interrupted sutures are also demonstrated. This video presents a refined and reproducible minimally invasive technique emphasizing surgical precision, safety, and standardized technical principles in the management of benign esophageal tumors.
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Authors Chanapat Limdamnoen, Jirawat Swangsri
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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/doag077.404
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.404/70761086/doag077.404.pdf
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