Skip to main content

Advertisement

Log in

Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Zenker’s diverticulum (ZD) is the most common diverticulum of the upper gastrointestinal tract. Various flexible endoscopic techniques have been used for division of the septum. However, the learning curve associated with these techniques might be difficult to overcome given the overall rarity of this condition. This can lead either to complications or to potential recurrence of symptoms. The authors hypothesized that a flexible bipolar hemostasis forceps developed for natural orifice translumenal surgery (NOTES) procedures would facilitate precise endoscopic diverticulotomy and simultaneously enable sealing of divided tissue edges.

Methods

Because the pharyngeal diverticulum (PD) in the pig is comparable with a human ZD, this nonsurvival model was used to perform endoscopic diverticulotomy using two energy technologies. The PD septum was dissected with either a flexible and a rotating bipolar forceps (n = 5) or with standard needleknife cautery (NK; n = 3). The feasibility and safety of the two technologies were compared.

Results

In contrast to NK myotomy, the bipolar forceps could easily be readjusted before any tissue dissection in all (5/5) interventions, and energy was applied only on the tissue to be divided. Tissue bonding at the edges of the septum was observed in all cases. The monopolar energy in NK dissection made precise and centered division of the septum difficult to achieve and did not bond the edges of the septum. One perforation occurred with NK (1/3).

Conclusions

The flexible bipolar forceps used for Zenker’s diverticulotomy is appealing due to its ease of application and potential to coaptate mucomuscular tissue edges. Although further evaluation with a survival model is necessary, it also seems to be a safer approach than NK. This novel tool could facilitate performance of surgical endoscopists and may make flexible endoscopy the preferred method for Zenker’s ablation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ferreira LE, Simmons DT, Baron TH (2008) Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 21:1–8

    Article  PubMed  CAS  Google Scholar 

  2. Huang BS, Unni KK, Paynen WS (1984) Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker’s) diverticulum. Ann Thorac Surg 38:207–210

    Article  PubMed  CAS  Google Scholar 

  3. Avisar E, Luketich JD (2000) Adenocarcinoma in a mid-esophageal diverticulum. Ann Thorac Surg 69:288–289

    Article  PubMed  CAS  Google Scholar 

  4. Tomos P, Karakatsani A, Lachanas E, Zarbis N, Koulouris NG, Lioulias A (2005) A rare cause of lobar pneumonia and tracheal stenosis: giant Zenker’s diverticulum. Respiration 72:650

    Article  PubMed  CAS  Google Scholar 

  5. Chang CY, Payyapilli RJ, Scher RL (2009) Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope 113:957–965

    Article  Google Scholar 

  6. Richtsmeier WJ (2005) Myotomy length determinants in endoscopic staple-assisted esophagodiverticulostomy for small Zenker’s diverticula. Ann Otol Rhinol Laryngol 114:341–346

    PubMed  Google Scholar 

  7. Vogelsang A, Preiss C, Neuhaus H, Schumacher B (2007) Endotherapy of Zenker’s diverticulum using the needleknife technique: long-term follow-up. Endoscopy 39:131–136

    Article  PubMed  CAS  Google Scholar 

  8. Seaman DL, a Levy J, Gostout CJ, Rajan E, Herman L, Knipschield M (2007) An animal training model for endoscopic treatment of Zenker’s diverticulum. Gastrointest Endosc 65:1050–1053

    Article  PubMed  Google Scholar 

  9. Mosher HP (1917) Webs and pouches of the esophagus: their diagnosis and treatment. Surg Gynecol Obstet 25:175–187

    Google Scholar 

  10. Dohlman G, Mattsson O (1960) The endoscopic operation for hypopharyngeal diverticula: a roentgencinematographic study. Arch Otolaryngol 71:744–752

    CAS  Google Scholar 

  11. Collard J-M, Otte J-B, Kestens PJ (1993) Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg 56:573–576

    Article  PubMed  CAS  Google Scholar 

  12. Sen P, Bhattacharyya MS (2004) Endoscopic stapling of pharyngeal pouch. J Laryngol Otol 118:601–606

    Article  PubMed  CAS  Google Scholar 

  13. Mirza S, Dutt SN, Irving RM (2003) Iatrogenic perforation in endoscopic stapling diverticulotomy for pharyngeal pouches. J Laryngol Otol 117:93–98

    Article  PubMed  CAS  Google Scholar 

  14. Mulder CJJ, den Hartog G, Robijn RJ, Thies JE (1995) Flexible endoscopic treatment of Zenker’s diverticulum: a new approach. Endoscopy 27:438–442

    Article  PubMed  CAS  Google Scholar 

  15. Tang SJ, Jazrawi SF, Chen E, Tang L, Myers LL (2008) Flexible endoscopic clip-assisted Zenker’s diverticulotomy: the first case series. Laryngoscope 118:1199–1205

    Article  PubMed  Google Scholar 

  16. Costamagna G, Iacopini F, Triangali A, Marchese M, Spada C, Familiari P, Mutignani M, Bella A (2007) Flexible endoscopic Zenker’s diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique. Endoscopy 39:146–152

    Article  PubMed  CAS  Google Scholar 

  17. Seaman DL, a Levy J, Gostout CJ, Rajan E, Knipschield M (2008) A new device to simplify flexible endoscopic treatment of Zenker’s diverticulum. Gastrointest Endosc 67:112–115

    Article  PubMed  Google Scholar 

  18. Park PO, Long GL, Bergström M, Cunningham C, Vakharia OJ, Bakos GJ, Bally KR, Rothstein RI, Swain PC (2010) A randomized comparison of a new flexible bipolar hemostasis forceps designed principally for NOTES versus a conventional surgical laparoscopic bipolar forceps for intraabdominal vessel sealing in a porcine model. Gastrointest Endosc 71:835–841

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Ethicon Endosurgery for kindly providing the flexible bipolar sealing forceps. The authors also thank Olympus USA for providing the dual-channel endoscope. The companies were not involved in the study design or data acquisition and interpretation.

Disclosures

Lee L. Swanström serves as a consultant for Ethicon Endosurgery. Erwin Rieder, Danny V. Martinec, and Christy M. Dunst have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Erwin Rieder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rieder, E., Martinec, D.V., Dunst, C.M. et al. Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection. Surg Endosc 25, 3273–3278 (2011). https://doi.org/10.1007/s00464-011-1704-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1704-3

Keywords

Navigation