Diverticulotomía endoscópica utilizando Ligasure™

Silva, Bruno A. Moreira da; Germade, A; Citores, Laura Pérez; Antolín, Sergio Maestro; Santos, F; Barranco, Fernando Sánchez; Millán, Antonio Pérez; Arisqueta, Francisco Igea

doi:10.1016/j.gastrohep.2016.04.001

Cited by 18 publications

(3 citation statements)

References 12 publications

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“…There are few reports on Ligasure for treatment of ZD, with the first dating from 2014 8 16 . Two small series 9 10 (n = 5 and 8) reported no recurrences after a mean follow-up of about 21 months, including a partial clinical improvement efficiently rescued with a second EDVL at 3 months. The procedures were performed, as in our series, under deep sedation with propofol, but patients were hospitalized for ≥ 24 hours while our patients were discharged after the procedure.…”

Section: Discussionmentioning

confidence: 96%

“…Different scalpels, monopolar coagulation forceps, laser and argon plasma have been used, together with use of transparent caps and flexible diverticuloscopes. In recent years, Ligasure (LS1500, Covidien, Medtronic, Minneapolis, Minnesota, United States), a system imported from laparoscopic surgery, has shown very good results in small series 8 9 10 . We present the largest series of patients with ZD treated by endoscopic diverticulotomy with Ligasure (EDVL) with a long follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

et al. 2019

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Background and study aims Zenker's diverticulum may cause disabling symptoms, especially in the elderly. Treatment has changed in recent decades from open surgery to management with flexible endoscopy, resulting in lower morbidity and mortality. The goal of this study was to present the largest series, with the longest follow-up, of patients with Zenker's diverticulum receiving outpatient treatment with flexible endoscopy using a diverticuloscope and Ligasure (Covidien, Minneapolis, Minnesota, United States), a device that allows tissue sealing and coagulation of vessels before cutting the septum between the diverticulum and esophagus. Patients and methods We performed 79 diverticulotomies in 69 patients (65.2 % male, mean age 73.4 years). The mean diverticulum size was 2.8 cm. In three cases with a diverticulum ≤ 1.5 cm, the diverticuloscope could not be placed. Results The technical success was 95.83 % and the clinical success 96.7 %: 84 % of the 56 patients followed for a mean of 34.6 months (24 – 64 months) had no dysphagia. The recurrence rate was 10.4 %, with a good response to a second diverticulotomy at 12 months (IQR: 11.5 – 17) in most cases. The most severe complications were two microperforations, resolved with conservative treatment, and one case of delayed bleeding endoscopically-controlled with a clip. Conclusions Diverticulotomy of the esophageal-diverticular septum with Ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with Zenker's diverticulum. In symptomatic recurrences, a second procedure was equally safe and effective in most patients.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

et al. 2019

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“…El tratamiento del DZ por endoscopia flexible fue descripto por primera vez en 1995 y actualmente es considerado un tratamiento eficaz y seguro 6,7 Consiste en la división del tabique entre el divertículo y el esófago, dentro del cual está contenido el músculo cricofaríngeo . 8 , 9 , utilizando diferentes instrumentos basados en la utilización de agujas de diatermia (Needle-knife), argón plasma, láser o coagulación con ultrasonido (Harmonicscalpel; EthiconEndoSurgery), cluth-cutter 10 , 11 , 12 , 13 Otro de los instrumentos utilizados más recientemente para realizar la miotomía ha sido el LigaSureTM (Covidien, Mansfield, MA), bisturí que se emplea en cirugía laparoscópica para la disección y sellado del colágeno 15 , 16 .Unade las cualidades de este dispositivo es que permite el sellado del tejido y la coagulación de los vasos antes de cortar el tabique entre el divertículo y el esófago.Este dispositivo de electrocirugía bipolar entrega alta intensidad de corriente y energía eléctrica de bajo voltaje junto con la presión que se ejerce desde las mordazas del dispositivo sobre eltejido.El sistema controla la energía y permite la desnaturalización del colágeno y elastina dentro de las paredes de los vasos 17 .…”

Section: Introductionunclassified

Tratamiento con endoscopía flexible del divertículo de Zenker

Gónzalez

Viola

Méndez³

et al. 2019

Cir. Urug.

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El tratamiento del divertículo de Zenker (DZ) ha evolucionado de la cirugía abierta a la endoscopía flexible, resultando en una menor morbilidad y mortalidad. El tratamiento endoscópico consiste en la miotomía del cricofaríngeo utilizando múltiples dispositivos de corte. Objetivo: El propósito de este estudio es mostrar una alternativa terapéutica por endoscopía flexible para el divertículo de Zenker, utilizando diferentes instrumentos de corte. Material y métodos: Se describe una serie de casos de pacientes con diagnóstico de divertículo de Zenker tratados por endoscopía, entre marzo de 2014 y julio de 2018. Todos los procedimientos fueron realizados por un único endoscopista. Se recabaron datos de los registros endoscópicos de forma retrospectiva y se analizaron variables demográficas, síntomas, aspectos técnicos, complicaciones y seguimiento. Resultados: Se incluyeron 12 pacientes, 7(58%) de sexo femenino, media de edad 69 años (rango: 53-90).Todos los pacientes presentaban disfagia para sólidos y líquidos, 2 pacientes tenían además síntomas respiratorios. El tamaño medio de los divertículos fue de 3,6 cm. Se realizó la miotomía con LigaSure en 4 pacientes, con clutch-cutter en 3 y needleknife en 5casos.En 11 (91,6%) casos se obtuvo mejoría de la sintomatología, 2(16%) pacientes presentaron recurrencia de los síntomas durante una mediana de seguimiento de 9 meses. Un caso (8%) requirió reintervención obteniéndose alivio de la disfagia. Se presentó microperforación en un paciente (8%), que se resolvió con tratamiento conservador. Conclusiones: La diverticulotomía mediante endoscopía flexible resultó ser eficaz y segura para el tratamiento del DZ, por lo que debería ser considerada en el arsenal terapéutico de esta patología. Palabras claves. Divertículo de Zenker, endoscopía flexible, tratamiento endoscópico, miotomía del cricofaríngeo.

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445nm Blue Laser for Cricopharyngeal Myotomy/Zenker's Diverticulotomy: Proof of Concept and Use

Tie,

Manayan,

Mallur

2024

The Laryngoscope

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Objective(s)Treatment for Zenker's diverticulum and cricopharyngeal dysfunction has evolved to include flexible endoscopic approaches. Currently, no flexible modalities combine the precision cutting of CO2 laser and the hemostasis of knife electrocautery. We present the first series describing fiber‐based 445nm blue light (BL) laser for endoscopic cricopharyngeal myotomy/Zenker's diverticulotomy. We describe usage characteristics and laser parameters with rigid esophagoscopy to determine the feasibility of use with flexible endoscopy.MethodsRetrospective review and literature review.ResultsThe first nine cases of endoscopic diverticulotomy (n = 5) and cricopharyngeal myotomy (n = 4) with BL were reviewed. Rigid exposure was achieved with the Dohlman Slimline diverticuloscope. Mean age was 75.6 years. Average diverticulum depth was 0.89 cm ±1.0 cm. Pulsed mode was used in seven cases with mean of 6.86 W, 54 ms pulse on, and 286 ms pulse pause and overall mean of 6.00 W and 405 J. Complete myotomy with intact buccopharyngeal fascia and without bleeding limiting view was achieved in all patients. One of two patients in whom continuous wave setting was used developed subcutaneous emphysema following vigorous cough on POD0; this resolved after 7 days nothing per oral (NPO). Eight patients were started on oral intake without evidence for leak. Pulsed mode with fiber‐to‐tissue contact provided effective muscle cutting without disruption of buccopharyngeal fascia. Literature review yielded three articles examining flexible approach with laser for Zenker's and none with BL.ConclusionBL provides safe and effective fiber‐based cutting and hemostasis in endoscopic cricopharyngeal myotomy/Zenker's diverticulotomy. Future use in flexible endoscopic approaches appears feasible, though continuous wave should be avoided.Level of EvidenceIV Laryngoscope, 2024

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Diverticulotomía endoscópica utilizando Ligasure™

Cited by 18 publications

References 12 publications

Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

Tratamiento con endoscopía flexible del divertículo de Zenker

445nm Blue Laser for Cricopharyngeal Myotomy/Zenker's Diverticulotomy: Proof of Concept and Use

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