Transoral endoluminal approach to Zenker's diverticulum using LigasureTM: early clinical experience

Abstract

The development of minimally invasive procedures has rekindled interest in endoluminal techniques for the management of Zenker's diverticulum. Tissue sealers as employed in laparoscopic surgery have not been previously used for Zenker's diverticulum septotomy. Supported by the established safety of linear cutters, bipolar forceps, and ultrasonic scalpels, we have started a procedure using the Ligasure 5 TM tissue sealer. Safety and efficacy results in our early clinical experience are shown for a prospective series of 5 consecutive Zenker's diverticulum cases that were perorally managed with tissue sealing. The procedure was quickly and safely performed in the endoscopy room under sedation. Mean number of seals per patient was 2, and mean procedure duration was 33 minutes. No complications developed during or after the procedure, and patients were discharged with immediate dysphagia relief and adequate oral tolerance. No diverticular relapses occurred after a mean follow-up of 21 months (range 18-30).This procedure may be repeated as often as desired with no need for hospital admission. Safety should be prospectively assessed by further studies using a higher number of procedures.

Flexible endoscopy assisted by Ligasure™ for treatment of Zenker’s diverticulum: an effective and safe procedure

“…Very little has been published about flexible endoscopy diverticulotomy and cricopharyngeal myotomy assisted by Ligasure™. Many case series in the literature have had smaller sample sizes and shorter follow-up period compared to our study [6,7,9,10,22]. Globally, Yuan et al [14] analyzed available data for endoscopic treatment (with a lot of heterogeneity), showing a success rate of 63-100%.…”

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

“…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.…”

“…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.…”