Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: An alternative minimally invasive approach

Abstract

Objectives/Hypothesis: Transoral treatment of cricopharyngeal bar and small Zenker's diverticulum remains a challenge. We propose a new transoral approach for transoral cricopharyngeal myotomy (TOCPM) for patients with cricopharyngeal spasm and pharyngeal bar, and for transoral resection of diverticula (TORD) with cricopharyngeal myotomy in the patient with small (<3 cm) Zenker's diverticulum.Methods: A retrospective review was conducted of 45 patients with cricopharyngeal spasm (21) and Zenker's diverticulum (24), where 14 patients were considered suitable for TORD and TOCPM. TOCPM used the Weerda laryngoscope (Karl Storz, Tuttlingen, Germany) to expose the cricopharyngeal bar using a microscope; the mucosa is cut and then the muscle is transected using monopolar cautery. A 0 endoscope is inserted through the incision to ensure complete myotomy. Incision closure is by interrupted 4-0 Vicryl sutures (Ethicon Inc., Somerville, NJ) and fibrin glue. For the TORD procedure, the diverticular sac is everted and then resected using scissors. Through the sac opening, the TOCPM is completed. The sac opening is then closed as described in TOCPM. The patients are kept without food for 24 hours, followed by feeding and discharge. Modified barium swallow (MBS) evaluated functional results.Results: Fourteen patients underwent TOCPM (eight), and TOCPMþTORD (six). There was one case of TOCPM that was aborted due to excessive bleeding, which prevented full myotomy. The rest did well. All were discharged the next day. Two poor results from the TOCPM and TOCPMþTORD group were due to poor esophageal motility. The remainder of patients had resolution of dysphagia and normalized MBS. No patient developed stricture or complications.Conclusions: Short segment Zenker's diverticulum and cricopharyngeal bar can now be addressed completely with a transoral approach. Because there is complete closure of the mucosal incision, prolonged hospitalization can be avoided.

Electro-haptic stimulation enhances speech recognition in spatially separated noise for cochlear implant users

“…The difference in arrival time and sound intensity between the ears (interaural time and level differences) are crucial cues for determining the location of a sound. CI users have limited access to these cues, especially the around 95% 14 of users who are implanted in only one ear 4 , 15 . As a result, CI users have smaller improvements in speech-in-noise performance than normal-hearing listeners when the speech and noise are spatially separated, particularly those that have only one implant 16 – 21 .…”

Subglottic Metastatic Rectal Adenocarcinoma: A Specialist Multidisciplinary Airway Team Approach for Optimized Voice and Airway Outcome

“…This experience highlights the risk of an unprotected friable wound in the airway. Fibrin glue (fibrin sealant) is composed of human plasma proteins and mimics the final pathway of the coagulation cascade, yielding a stable and insoluble clot [9]. The role of fibrin sealants throughout surgery is expanding and the use of fibrin has been described to line the repair of cricopharyngeal myotomy and in tracheal lacerations [9, 10].…”

“…Fibrin glue (fibrin sealant) is composed of human plasma proteins and mimics the final pathway of the coagulation cascade, yielding a stable and insoluble clot [9]. The role of fibrin sealants throughout surgery is expanding and the use of fibrin has been described to line the repair of cricopharyngeal myotomy and in tracheal lacerations [9, 10]. Our patient suffered no complications associated with the use of fibrin glue and we have demonstrated that Tisseel can be applied to the larynx with the use of jet ventilation provided a pause in ventilation is permitted.…”

A new paradigm of endoscopic cricopharyngeal myotomy with CO2 laser

“…The ECPM is obviously a less invasive technique and requires less operating time than the TCPM 3–5. The mucosa‐covered cricopharyngeal muscle is easily identified as the mound of tissue just proximal to the esophageal introitus (Fig.…”

“…1A)1, 3 and is able to selectively cut off the horizontal part of the cricopharyngeal muscle that is absent of the median pharyngeal raphe 6. The resection of the horizontal part alone will have a sufficient effect for such conditions as Zenker's diverticulum 4. But if a sufficient opening by this part's resection (Fig.…”