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Surgical Endoscopy

, Volume 24, Issue 1, pp 215–218 | Cite as

Enucleation of a leiomyoma of the mid-esophagus through a right thoracoscopy with the patient in prone position

  • Giovanni DapriEmail author
  • Jacques Himpens
  • Ruffin Ntounda
  • Stephane Alard
  • Etienne Dereeper
  • Guy Bernard Cadière
Dynamic Manuscript

Abstract

Background

Leiomyoma is the most common benign esophageal neoplasm. Different open and minimally invasive approaches have been described. We describe a right thoracoscopic enucleation with the patient in the prone position.

Method

A 49-year-old woman consulted us about solid-diet dysphagia without other symptoms. Preoperative work-up showed the presence of 50 × 28-mm leiomyoma of the middle esophagus, without satellite lymph nodes. The patient underwent general anesthesia with a double-lumen endotracheal tube, and subsequently was placed in the prone position. A 30° scope was introduced in the right 7th intercostal space on the posterior axillary line. Perioperative gastroscopy permitted localization of the lesion, which appeared to be situated at the level of the azygos vein. Two 5-mm trocars were inserted in the right 5th and 9th intercostal spaces on one line with the first one. The azygos vein was ligated. The muscular layer of the mid-esophagus was opened by coagulating hook. Due to a 2-mm trocarless Cadière’s forceps (Microfrance, France), introduced into the right 7th intercostal space, the operative field was well exposed and the lesion was enucleated without mucosal perforation. The muscular layer was closed by interrupted silk 2/0 stitches. A drain was left in the chest cavity.

Results

Total operative time was 85 min and blood loss was less than 20 ml. The gastrograffin swallow on postoperative day 2 showed good clearance of the esophagus and absence of leak, hence the patient was allowed a liquid diet. The patient was discharged on postoperative day 3. Benign pathology was confirmed.

Conclusion

Thoracoscopy in the prone position permits the surgeon to reach the esophagus under excellent working conditions, despite an only partially deflated lung. Gravity displaces blood loss eventually, which allows good visualization, and the surgeon can operate in an ergonomic position. This approach allows for fewer trocars which favorably influences the patient’s comfort and reduces the length of hospital stay.

Keywords

Esophageal leiomyoma Thoracotomy Thoracoscopy Laparoscopy Prone position 

Supplementary material

Supplementary material 1 (MPG 52453 kb)

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Giovanni Dapri
    • 1
    Email author
  • Jacques Himpens
    • 1
  • Ruffin Ntounda
    • 2
  • Stephane Alard
    • 3
  • Etienne Dereeper
    • 4
  • Guy Bernard Cadière
    • 1
  1. 1.Department of Gastrointestinal Surgery, European School of Laparoscopic SurgerySaint-Pierre University HospitalBrusselsBelgium
  2. 2.Department of Gastroenterology and EndoscopySaint-Pierre University HospitalBrusselsBelgium
  3. 3.Department of RadiologySaint-Pierre University HospitalBrusselsBelgium
  4. 4.Department of AnesthesiologySaint-Pierre University HospitalBrusselsBelgium

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