THORACOSCOPIC EXCISION OF DISTAL ESOPHAGEAL DUPLICATION CYST

Space: IPEG Published: 2023-07-20

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Timestops

Introduction to Esophageal Duplication Cysts

Overview of esophageal duplication cysts, their presentation in childhood, and the case of a 15-year-old patient with a mediastinal cyst.

Surgical Preparation and Positioning

Description of the surgical setup, including patient positioning and port placement for thoracoscopic surgery.

Initial Dissection and Identification

Details of the initial dissection around the cyst and identification of the esophagus and surrounding structures.

Cyst Dissection and Management

Techniques used to dissect the cyst from the esophagus, including suctioning of cyst contents and careful dissection.

Final Steps in Cyst Excision

Final dissection steps to remove the cyst completely and ensure no communication with the esophagus.

Postoperative Management

Discussion of postoperative care, including the use of a bougie tube and Blake drain, and the patient's discharge.

Categories

Specialty

General Surgery Pathology Pediatric Surgery Pulmonology

Anatomy/Organ System

Cardiovascular System Nervous System Respiratory System

Diagnostic/Imaging Modality

MRI Pathology

Population

Pediatric

Topic Format

Technique Videos/OP Notes

Clinical Task

Imaging Management Post-op

Keywords

thoracoscopic excision distal esophageal duplication cyst dysphagia mediastinal cyst MRI esophagus dissection cyst removal ligature device bougie tube Blake drain suction circumferential dissection pediatric surgery thoracic surgery cystic lesions anterior mediastinum surgical technique postoperative care esophageal pathology

Hashtags

#ThoracoscopicSurgery #EsophagealCysts #PediatricSurgery #MediastinalCysts #Dysphagia #SurgicalTechniques #EsophagealSurgery #CystRemoval #ThoracicSurgery #MRI #Dissection #SurgicalEducation #PatientCare #CysticLesions #BougieTube #BlakeDrain #SurgicalOutcomes #EsophagealPathology #MinimallyInvasiveSurgery #CystExcision

Transcript

Great. Thank you for the opportunity to present. Thoracoscopic excision of distal esophageal duplication cyst. Esophageal duplication cysts are less common compared to other forgot duplication cysts. They typically present in childhood with dysphagia. This is a 15 year old child with a history of back pain. MRI of the spine demonstrated a mediastinal cysts. Located anterior to the aorta above the diaphragm, we began with the patient in the supine position and placed a bump under the right side. 35 millimeter ports were inserted, taking down the inferior and pulmonary ligament with ligature, and then we could see the cava entering the heart. And so we began working behind this and then were able to identify the esophagus and began slowly to dissect around. The cyst we saw the cyst maturing on the anterior portion of the esophagus. We continued to make slightly deeper plains until we were directly on the cyst and then we began to work over the top of it and inferiorly until we were circumferentially free except for the esophagus. At this point, we began peeling some of the esophagus. Down anteriorly and we saw some spillage of material from the cyst, so this was suctioned. And then we could see the back wall of the cyst. Which did not lead to a direct communication with the esophagus. With the cysts now empty, we were able to carefully dissect. The cyst off of the esophagus, removing layers in order to be able to see where the cysts joined. The esophagus. This dissection was carefully performed with a ligature device. We were ultimately able to get the ligature underneath the final attachment between the esophagus and the cyst. This allowed us to get the entire cyst cavity out and blocked. We were then able to place a 40 French bougie tube and move it back and forth, and then through one of the 5 millimeter port site placed the number 15 Blake drain. Slowly, the cyst was excised lagoscopically. The patient was discharged the same day. All right, thank you.

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