Leiomyoma is the most common benign mesenchymal esophageal tumor, representing up to 80% of benign esophageal tumors. Anatomically these neoplasms are localized to the middle and lower thirds of the esophagus, in most cases as a single lesion . The most common symptoms include dysphagia and atypical chest pain. Surgical intervention is indicated not only for pain but also in asymptomatic patients in order to prevent the excessive growth that can complicate patient well-being and future surgical resection. For resection of a leiomyoma, the patient is placed in the left lateral decubitus position and a robotic-assisted thora-coscopy is performed via five trocars. Circumferential dissection of the esophagus is performed using the hook electrocautery robotic extension. The articulated instruments allow the surgeon to place the grasper behind the esophagus without producing torque, which is frequent with rigid thoracoscopic instruments and facilitate a safe dissection of tumors that lie near the azygous vein. The isolation of the tumor starts by transecting the longitudinal muscular layer (myotomy), us-
ing the articulating robotic electrocautery. Then, blunt and sharp dissection is used to enucleate the tumor from the esophageal wall (Fig. 9.4). The articulating wrists allow a precise closure of the myotomy in a running fashion to complete the procedure. In our series, we have not seen mucosal injury, which we attribute to the better visualization, precise dissection afforded by the articulated instruments, and tremor control provided by the robotic system .
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