Endoscopic stapler-assisted Zenker's diverticulotomy: The surgical technique with video

Objective The aim of the present article is to describe step by step the endoscopic stapler-assisted Zenker's diverticulotomy (ESD) and to show in details pre- and post-operative management. Study design Case study with instructional video. Setting Department Of Otolaryngology, San Bortolo Hospital of Vicenza. Background Several comparable surgical approaches have been proposed for the treatment of hypopharyngeal Zenker's diverticulum, however determining the best operative facility in terms of safety, outcomes and hospital stay is still a matter of debate. In this scenario the endoscopic treatment of Zenker's diverticulum using the stapler device permits simultaneous sectioning and suturing of the septum between the pouch and esophagus, creating a more functional common cavity. Methods We here present a step by step description of an endoscopic treatment of Zenker's diverticulum using the stapler device. Common referral symptoms are persistent hoarseness and globus sensation associated with transient dysphagia. An endoscopic dynamic examination of upper airway may reveal the presence of a hypopharyngeal pouch, which should be confirmed by a fluoroscopic barium esophageal radiography. If a Zenker's diverticulum is diagnosed, an endoscopic single or multiple diverticulotomy with a stapler device is indicated. The patient may be discharged after 24–48 h without any dietary restrictions, once a post-operative esophageal radiography rules out any sort of perforation. Conclusion It is of relevance to precisely know the Endoscopic Stapler-assisted Zenker's Diverticulotomy as it represents a safe and efficient procedure and ensures good outcomes with the benefit of being performed even on a planned 24-hour-stay basis.