Please explain the educational or technical point that this video addresses.: This is the most novel approach to treatment of Zenker's or other proximal esophageal diverticula. It is the most versatile and least invasive technique. We have totally moved to this technique as our first-line standard for treatment of proximal esophageal diverticula.
Thoracic surgeons can learn this technique. We have used this video in addition to personalized in-person and remote coaching to help surgeons implement this technique.
Please provide a 250 word summary of the surgical video being submitted.: We present tyhe technique with modifications to the peroral endoscopic myotomy for Zenker’s diverticulum (Z-POEM). We believe this leads to increased effectiveness, safety, and durability of results.
The patient is a sixty-nine-year-old man with a significantly symptomatic Zenker’s diverticulum as shown on a preoperative barium swallow. The patient had limited mouth opening and comorbidities that make the endoscopic stapled and open surgical options less feasible and desirable.
The surgical video breaks down the procedure step by step, including preoperative preparation, materials, and technical modifications and pearls which make Z-POEM highly effective and safe in the treatment of this disease.
Later in the video, we show temporal improvement in the Dakkak dysphagia score and Eckardt dysphagia score from preoperatively up to four years postoperatively. We also show immediate and four-year postoperative barium swallows, which demonstrate complete obliteration of the diverticulum with no impedance to contrast flow at the upper esophageal sphincter.
We believe that this Z-POEM technique is superior to endoscopic stapled myotomy, which requires the insertion of the Weerda scope and performs incomplete myotomy due to residual muscle at the tip of the stapler. Compared to the open repair, Z-POEM is incisionless and carries no risk to the recurrent laryngeal nerve. It can also be employed in small and large diverticula alike, with no imposed technical limitations.
It is the most versatile and least invasive technique. Thoracic surgeons can learn this technique.
Learning Objectives:
Identify the steps required to perform an endoscopic cricopharyngeal myotomy
