Thoracoscopic enucleation of esophageal leiomyoma in semi-prone position: how I do it

Abstract: Leiomyoma is the most common benign tumor of the esophagus. Surgical enucleation is indicated in case of symptoms or tumor size over 2 cm. Thoracoscopic enucleation is the standard procedure in the treatment of thoracic esophageal leiomyoma, with many advantages compared to open surgery: less pain, reduced complications, early recovery, short hospital stay. In practice, the semi-prone position is most often used due to its many advantages: no need for retractors to lift the lungs, limited blood and fluid accumulation in the surgical field and especially the spacious and easy to manipulate surgical field. The main goal of surgery is to completely remove the tumor without causing complications, especially mucosal injuries. The most important issues in surgery include: thoracic approach, determining tumor location, mobilizing, enucleation the tumor from the esophageal wall, and check the integrity of the esophageal mucosa. However, depending on the location, size, and morphology of the tumor, the surgeon also needs to make technical adjustments to make the surgery safe and convenient. In this video, we present the technique of thoracoscopic enucleation of an esophageal leiomyoma with the patient in the semi-prone position. In addition, we also present some technical experience in ablation of large tumors or complex shapes tumors.