Robotic extended esophageal myotomy: A novel minimally-invasive approach to the treatment of esophageal leiomyomatosis

Esophageal leiomyomatosis is a rare disorder involving diffuse proliferation of esophageal smooth muscle leading to dysmotility. Currently, the standard operative treatment of this disorder is esophagectomy with reconstruction. Long esophageal myotomy has been proposed as an alternative to the highly morbid esophagectomy. However, long esophageal myotomy has been hampered by inconsistent relief of dysphagia, esophageal perforation and fistula formation. To date, no minimally invasive approaches have been reported. We present a patient with esophageal leiomyomatosis who underwent a right robotic thoracoscopic long esophagomyotomy without complications and complete relief of dysphagia immediately after surgery. The symptomatic relief has persisted at 12 month follow up. The surgical approach was enabled by the advantages of robotic technology, namely high resolution three-dimensional visualization and precise instrument maneuverability in a confined space. This technique presents a new paradigm for the minimally invasive surgical treatment of patients with esophageal leiomyomatosis.