Endoscopic Surgery for a Benign Esophageal Stensosis without open Thoracotomy

Roh, Sung Kyu; Lee, Soo Jung; Kwun, Koing Bo

Abstract

Surgery for a mid-esophageal lesion requires an open thoracotomy, But authors resected out a stenotic thoracic esphageal lesion with laparoscopic instrument without open thoracotomy. The patient was 50 years old woman with a long history of progressive dyaphagia. A small (3 cm in diameter) smooth ovoid submucosal mass lesion was found at 26 cm distal from incisor on both esophagoscopy and esophagogram. Two 5 mm and two 10 mm trocars were inserted into the right pleural cavity under general anesthesia with double lumen endotracheal tube, An induced pneumothorax by insuffulation of CO2 gas made lung collapse and a good exposure of esophagus. Transorally introduced esophagoscope helped to demonstrate the exact location of lesion and also to give a guide at safe excision of mass with prevention of mucosal perforation. The lesion was found to be a congromeration of an inflammed hilar lympnode and hypertorphic esophageal muscle. The entire lesion was carefully dissected from esphageal mucosa and resected out en bloc. A chest tube was introduced through a trocar site. The lung was reinflated immediately. Post-operatively patient was very comfortable. Laparoscopic surgery is very effective and safe, and it could be applied for the resection of lung bullae, benign pulmonary neoplasm and for an excision of benign esophageal tumor.