PS01.036: THORACOSCOPIC ENUCLEATION OF BENIGN LESIONS OF THE ESOPHAGUS WITH PATIENT IN PRONE POSITION

Abstract

Abstract Background Benign lesions of the esophagus are rare, leiomyoma is the most common. Minimally invasive thoracoscopic enucleation is the currently best approache. We present our experience of thoracoscopic enucleation with patient in the prone position Methods Between June 2010 and December 2017 all patients referred to our Institute for symptomatic benign lesions of the esophagus underwent thoracoscopic enucleation in prone position. After single-lumen endotracheal intubation patients were placed in prone position. A right pneumothorax at 8 mmHg was created with a port at the apex of the scapula; two or three operative trocars were inserted in the right 5th and 9th intercostal spaces. The mediastinal pleura and the muscular layer over the lesion were incised and split using a coagulating hook. The lesions were carefully enucleated. The myotomy was closed with interrupted stitches. An intercostal drain was left in the right chest. Results 5 patients (3 males and 3 females) underwent thoracoscopic enucleation in prone position, without any conversion. Median operative time was 90 minutes (60–170), blood loss was minimal, there were no intraoperative or postoperative complications. 1 lesion was in the upper esophagus, 2 in the middle and 2 in the lower esophagus. The median post operative hospital stay was 9 days (9–11). Histopathology reveal 4 leiomyomas and 1 esophageal bronchogenic cyst. The median size of the lesions was 7.25 cm (3–9). In the follow up there weren’t recurrence or other symptoms. Conclusion Prone thoracoscopic enucleation of benign lesions of the esophagus is safe and feasible also for lesions > 5 cm; it permits an ergonomic position and a wide, clean operative field. Double lung ventilation and less post operative pain can reduce pulmonary complications Disclosure All authors have declared no conflicts of interest.