Hand-assisted laparoscopic transhiatal approach for mediastinal esophageal duplication cyst resection

Esophageal duplication cyst is a rare congenital esophageal disorder. Although these cysts are usually resected via thoracotomy, a minimally invasive approach has recently been suggested to avoid a long hospital stay. Here, we report a case of mediastinal esophageal duplication cyst that was successfully treated using a laparoscopic transhiatal approach. The patient was a 68-year-old male who had previously undergone renal transplantation (3 years ago). At that time, a computed tomography scan showed a cystic lesion in the lower thoracic esophagus, and an esophageal duplication cyst was suspected. During the follow-up, the tumor gradually increased in size, reaching around 35 mm in size. Therefore, we resected the mediastinal esophageal duplication cyst via a laparoscopic transhiatal approach. With the patient in a supine position, an upper abdominal incision (70 mm) was made, and Lap Discs were put in place and used for hand assistance. Three 12 mm ports were inserted in both flanks and the left hypochondrium. One 5 mm port for a videoscope was inserted into the lower abdomen. Using hand assisted laparoscopic surgery, the esophageal hiatus was divided, and carbon dioxide was introduced into the mediastinum. After the abruption of the distal esophagus with a blunt tip dissector, an esophageal duplication cyst with a smooth surface was detected. We carefully exfoliated it from the surrounding tissues and extracted it via a transhiatal approach without injuring the adventitia of the esophagus. The operative time was 245 min, and 30 ml of intra-operative bleeding were observed. The patient was discharged at 8 days after the operation without complications. The histopathological findings were compatible with esophageal duplication cyst. Our surgical procedure produced a good surgical view and made it possible to resect the esophageal duplication cyst via a transhiatal approach and decrease surgical stress.