Endoscopic diverticulotomy using 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.gastre.2016.04.011

Cited by 10 publications

(15 citation statements)

References 12 publications

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“…Bipolar sealing devices have also been described in a handful of cases, with similar results (14,20).…”

Section: Rigid Endoscopic Surgerymentioning

confidence: 80%

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Zenker’s diverticulum: flexible versus rigid repair

Beard¹,

Swanström²

2017

J. Thorac. Dis.

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Zenker's diverticula (ZDs) are a relatively common cause of cervical dysphagia. Diagnosis is best by a good upper GI exam though upper endoscopy should be performed as well. Treatment is either by open, transcervical approaches or trans-oral. Over the past 20 years, transoral approach has mostly replace transcervical approaches due to less pain, no scarring and a rapid recovery. Transoral approaches are either using rigid access or flexible endoscopy. Today, the most common approach is transoral stapling using a 12 mm laparoscopic linear cutting stapler. This has the drawbacks of requiring extreme neck extension, the massive size of the stapler making visualization mostly impossible and the current staple design that does not cut/staple all the way to the end of the blades-resulting in a residual pouch. Flexible endoscopy allows a more tailored approach under direct vision, the myotomy can even be extended beyond the diverticulum and onto the esophageal wall to minimize the risk of incomplete myotomy. Experienced endoscopists report high technical success and low complication. Success rates are similar but maybe slightly higher than with ridged transoral approaches or open surgery. Today, flexible endoscopic Zenkers is our preferred initial approach-with open or ridged being reserved for special indications.

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“…Bipolar sealing devices have also been described in a handful of cases, with similar results (14,20).…”

Section: Rigid Endoscopic Surgerymentioning

confidence: 80%

“…Non-stapled devices utilized for rigid endoscopic treatment of ZD include electrocautery, CO2 laser, and more recently Harmonic or LigaSure dissectors (14,15). Using similar diverticuloscope setup, these tools are used to divide the common wall septum of the diverticulum.…”

Section: Rigid Endoscopic Surgerymentioning

confidence: 99%

Zenker’s diverticulum: flexible versus rigid repair

Beard¹,

Swanström²

2017

J. Thorac. Dis.

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“…4 Ligasure use with FED was reported in 8 patients, with only 1 recurrence and a single complication of mild hematemesis. 5…”

Section: Discussionmentioning

confidence: 99%

Flexible Endoscopic Zenker’s Diverticulotomy with an Articulating Bipolar Energy Sealer

Weissbrod

Jafari

Liu

et al. 2019

Otolaryngol.--head neck surg.

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The surgical management of Zenker’s diverticula is performed through open or endoscopic approaches. The purpose of this report is to review our early experience with flexible endoscopic diverticulotomy with an articulating bipolar energy sealer for cricopharyngeal and diverticular wall division in a series of 5 patients where transoral rigid access was not possible. In addition to technical details, safety and efficacy data are included. The average diverticulum size was 2.5 cm. All patients reported symptom resolution, and there were no surgical complications. Liquid diet was initiated on postoperative day 1 for all patients and solids on day 11.8 ± 14.4 (mean ± SD) per protocol. Results demonstrate that treatment of Zenker’s diverticula can safely and successfully be performed with flexible endoscopic visualization and utilization of an articulating bipolar energy sealer to perform diverticulotomy in a population of patients where transoral diverticulotomy would not otherwise be feasible due to anatomic constraints. Early results support obtaining further experience to study this technology as an alternative to open surgery, especially when visualization and access are suboptimal with rigid endoscopy.

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“…Recently, the role of Ligasure (LS1500, Covidien; Medtronic, Minneapolis, MN, USA) has been evaluated for endoscopic diverticulotomy (Fig. d) . The Ligasure vessel sealer is used to dissect the tissue and simultaneously provide hemostasis at the site.…”

Section: Emerging Devicesmentioning

confidence: 99%

“…4d). 64 The Ligasure vessel sealer is used to dissect the tissue and simultaneously provide hemostasis at the site. In this small study (N = 8), technical success rate was 100% on a range of diverticular sizes, with one case of bleeding reported as the only complication.…”

Section: Emerging Devicesmentioning

confidence: 99%

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

Ishaq

Sultan

Siau

et al. 2018

Digestive Endoscopy

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Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored. Over the last two decades, the advent of new accessories and techniques have changed the landscape of endotherapy for ZD, with the current armamentarium including, but not limited to, endoscopic stapling, CO laser, argon plasma coagulation, needle knife, bipolar forceps, hook knife, clutch cutter, stag beetle knife, and submucosal tunneling endoscopic septum division. We hereby review the latest evidence to support the endoscopic management of ZD.

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Endoscopic diverticulotomy using Ligasure™

Cited by 10 publications

References 12 publications

Zenker’s diverticulum: flexible versus rigid repair

Zenker’s diverticulum: flexible versus rigid repair

Flexible Endoscopic Zenker’s Diverticulotomy with an Articulating Bipolar Energy Sealer

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

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