초록접수 현황
| 15F-041 | Video session발표 |
Repair of Transected Esophageal Mucosa and Coverages with Parietal Pleural Flap for Incidental Mucosal Tearing during Robot-assisted Enucleation of Hugh Esophageal Leiomyoma
박성용
아주대학교 의과대학 아주대학교의료원 흉부외과학교실
Background : This video demonstrates the repair of transected esophageal mucosa and coverages with parietal pleural flap for incidental mucosal tearing during Robot-assisted enucleation of hugh esophageal leiomyoma.
Methods : A 32-year-old male patient appealed dysphagia and chest discomfort. He was diagnosed as hugh esophageal submucosal tumor which totally encircled the mucosal layers on esophagogastroscopy and endoscopic ultrasonography. Robotic enucleation of submucosal tumor was planned.
Results : In semiprone position, two 12mm trocars and two 8mm trocars were made. The azygous vein was divided with hemolock clip. The muscles layers of esophagus were opened after confirming the vagus nerve, and hugh submucosal tumor which totally encircled mucosal layer was identified. During the enucleation submucosal tumor, esophageal mucosa was torn incidentally and the tearing sites were expanded during operation and the mucosa was transected. The torn mucosa was sutured with PDS 4-0 by interrupted manner and muscle layers were repaired with same manner. The parietal pleura was harvested and the esophagus was reinforced with parietal pleural flap. On pathologic examination, the submucosal tumor was confirmed as esophageal leiomyoma measuring the 9x7.5cm. On the esophagography performed on postoperative day 7, contained leakage was observed. On esophagogastroscopy performed on postoperative day 14, the mucosal layers were healed and oral diet was started. Six months after operation, patient has no symptoms relating the esophageal stenosis.
Conclusion : Even though esophagectomy and gastric reconstruction was generally indicted in case of hugh leiomyoma, encircling growth pattern or intraoperative tearing of esophageal mucosa, robotic systems enabled the enucleation of hugh leiomyoma mucosal repair with avoiding the esophagectomy.
Methods : A 32-year-old male patient appealed dysphagia and chest discomfort. He was diagnosed as hugh esophageal submucosal tumor which totally encircled the mucosal layers on esophagogastroscopy and endoscopic ultrasonography. Robotic enucleation of submucosal tumor was planned.
Results : In semiprone position, two 12mm trocars and two 8mm trocars were made. The azygous vein was divided with hemolock clip. The muscles layers of esophagus were opened after confirming the vagus nerve, and hugh submucosal tumor which totally encircled mucosal layer was identified. During the enucleation submucosal tumor, esophageal mucosa was torn incidentally and the tearing sites were expanded during operation and the mucosa was transected. The torn mucosa was sutured with PDS 4-0 by interrupted manner and muscle layers were repaired with same manner. The parietal pleura was harvested and the esophagus was reinforced with parietal pleural flap. On pathologic examination, the submucosal tumor was confirmed as esophageal leiomyoma measuring the 9x7.5cm. On the esophagography performed on postoperative day 7, contained leakage was observed. On esophagogastroscopy performed on postoperative day 14, the mucosal layers were healed and oral diet was started. Six months after operation, patient has no symptoms relating the esophageal stenosis.
Conclusion : Even though esophagectomy and gastric reconstruction was generally indicted in case of hugh leiomyoma, encircling growth pattern or intraoperative tearing of esophageal mucosa, robotic systems enabled the enucleation of hugh leiomyoma mucosal repair with avoiding the esophagectomy.
책임저자: 박성용
아주대학교 의과대학 아주대학교의료원 흉부외과학교실
연락처 : 박성용, Tel: 031-219-4455 , E-mail : psy1117@hanmail.net
