Epiphrenic diverticulum: Robotic-assisted transhiatal approach

Surgery of the epiphrenic diverticulum has been related to high postoperative morbidity. Even through a minimally invasive approach, dissection of the neck-proximal portion of the diverticulum can be difficult. Robotic-assisted (RA) technologies have been developed recently. We describe our experience of RA transhiatal diverticulectomy in 2 patients: (1) A 73-year-old female patient who presented with 2 large esophageal diverticula at the mid esophagus and gastroesophageal junction, and a large hiatal hernia. A RA transhiatal diverticulectomy and Nissen fundoplication were performed, although intense adhesions made a limited thoracotomy necessary. The patient developed a mild esophageal leak, which resolved successfully with conservative treatment; (2) A 63-year-old male patient with a large epiphrenic diverticulum, which was resected using the RA transhiatal approach, and a Toupet fundoplication was also performed. The postoperative course was uneventful. We believe that RA transhiatal management of epiphrenic diverticulum can help during the dissection of the proximal portion of the diverticulum and might reduce postoperative morbidity.