Leiomiomas do esôfago removidos por vídeo-toracoscopia

Videothoracoscopic resection of esophageal leiomyomas

Thoracic surgery; Esophageal surgery; Surgical techniques; Benign esophageal neoplasms; Benign neoplasm

RELATOS DE CASOS

Leiomiomas do esôfago removidos por vídeo- toracoscopia

Videothoracoscopic resection of esophageal leiomyomas

João Luiz M. C. Azevedo, TCBC-SP^I; Jean Boulez^II; Otávio Azevedo^III

^IProfessor Adjunto Doutor do Departamento de Cirurgia da Universidade Federal de São Paulo (UNIFESP), Escola Paulista de medicina (EPM-SP). Professor convidado da Universidade Claude Bernard, Lyon, França

^IIProfessor Titular do Departamento de Cirurgia Geral e Digestiva da Faculdade de Medicina da Universidade Claude Bernard, Lyon, França

^IIIResidente de Cirurgia Gastroenterológica do Hospital do Servidor Público do Estado de São Paulo

^{Endereço para correspondência}

ABSTRACT

This report describes three cases of esophageal leiomyomas successfully resected by thoracoscopy. Surgical enucleation through minimally invasive surgery is the treatment of choice for esophageal leiomyoma. The conventional approach through a formal thoracotomy has the potential of causing excessive pain and patient discomfort. Moreover, the hospital stay and the recovery period are prolonged. Indications for surgery were based mainly on the size of the mass (<4 cm) and the presence of dysphagia. In one case there was a clear suspicion of malignancy. The tumour was located in the lower thoracic esophagus (case 1), in the middle thoracic esophagus (case 2) and in the upper esophagus (case 3). The CT was useful in identifying the relationship between the lesion and the organs of the mediastinum. The barium swallow study was able to locate the lesion along the esophagus. The endosonography determined the boundaries of the lesions. A right thoracoscopic approach was undertaken. Dissection of the esophagus around its entire perimeter was never necessary because all tumours were anterior or right sided. The tumours were better grasped with a traction suture than with forceps. The hidrodissection was very helpful. The water-soluble contrast swallow, performed on the fourth postoperative day, was normal. Clinical results were satisfactory in all patients. Biopsies should never be performed when the mucosa overlying is normal.

Key words: Thoracic surgery; Esophageal surgery; Surgical techniques; Benign esophageal neoplasms; Benign neoplasm.

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Recebido em 25/1/99

Aceito para publicação em 28/10/99

Trabalho realizado no Serviço de Chirurgie Générale et Digestive, Fédération des Spécialités Digestives, Pavillon D-O, Hospital Edouard Herriot, Lyon, França.

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Datas de Publicação

• Publicação nesta coleção
  31 Jul 2009
• Data do Fascículo
  Fev 2000

Histórico

• Aceito
  28 Out 1999
• Recebido
  25 Jan 1999