Antonio M. Lacy, Dulce Momblan, Elizabeth Pando
Hospital Clínic, Barcelona, Spain
A 30 years old male patient, with history of smoking, grandparents that suffered from colorectal, breast and lung cancer (appeared at an age of 45); suffered from chest pain.
He underwent a thoracic X-Ray that showed a mediastinal mass. Further investigation was performed with a CT-Scan that demonstrates a lesion of almost 6 cm in the middle third of the esophagus, this mass had annular form and was producing mild dilatation of the proximal esophagus, there was contact with the trachea and aorta. By upper endoscopy the lesion was at 21 cm from the dental arch, with normal mucosa and produced extrinsic compression of the lumen. The endoscopic ultrasound corroborate the annular disposition of the tumor, non pathological lymph nodes were found. The biopsy and immunohistochemistry obtained by fine needle puncture were compatible with benign leiomyoma.
This patient was proposed to perform surgical treatment and underwent a minimally invasive enucleation of the tumor. The approach was accomplished by thoracoscopy, using a 3D camera with a flexible tip. A total of 3 ports were used, one of 12mm for the camera at the 7th intercostal space and two of 5mm placed at the 5th and 9th intercostal space.
The patient was positioned in prone position, using selective airway intubation. The key steps of the procedure included: opening of the parietal pleura, ligation of the azygos vein, division of the muscular wall and individualization of the tumor (hook and blunt dissection), closure of the muscular wall, revision for hemostasis and extraction of the specimen, a single fine chest tube was placed.
Surgical time was 120 min without any events.
The patient had an correct postoperative course, oral intake started on second day after surgery and the chest tube was removed two days later. Hospital stay was five days and the follow up one month after surgery was correct.