Analysis of Thoracoscopic Enucleation Combined with Esophagoscopy in the Prone Position for Esophageal Submucosal Tumor.

Background: Esophageal submucosal tumors (SMTs) are rare, occurring in less than 1% of esophageal neoplasms. For surgical treatment of esophageal SMTs, enucleation is usually the procedure of choice for benign tumors. This study aimed at evaluating the surgical technique and outcomes of thoracoscopic enucleation with esophagoscopy for esophageal SMTs. Methods: Patients with esophageal SMTs who underwent thoracoscopic enucleation between 2015 and 2022 were retrospectively investigated. Surgery was performed with the patient in the prone position. First, an esophagoscope was inserted, and a sodium hyaluronate solution with indigo carmine dye was injected into the submucosal layer just below the tumor. Next, under thoracoscopy, the tumor was exposed through a thoracoscopic incision and dissection of the muscularis propria and adventitia was performed at the tumor site. The colored layer resulting from the previously injected dye was identified, and tumor enucleation was performed under guidance of the dye so as not to damage the mucosa or pseudocapsule. Results: In total, 5 surgeries were performed. The mean operative time was 122.6 minutes (range 84-168 minutes), mean blood loss was 21.1 mL (range 0-80 mL), and mean postoperative hospital stay was 8 days (range 7-10 days). There were no postoperative complications. Pathological diagnosis revealed 2 cases of gastrointestinal stromal tumors, 2 cases of schwannoma, and 1 case of leiomyoma. Conclusions: We believe that this technique is a useful and safe method of performing thoracoscopic enucleation of esophageal SMTs because the injected dye provides an indicator of the resection line during enucleation.

Presentation of unruptured right gastric aneurysm due to segmental arterial mediolysis resected laparoscopically: A case report.

INTRODUCTION: Timely diagnosis and treatment of intra-abdominal arterial aneurysms before rupture are highly recommended. We successfully prevented rupture through arterial aneurysm excision, highlighting the importance of the lack of reports on resection before rupture. CASE PRESENTATION: A 60-year-old male with previous history of ureteral stones presented complaining primarily of left-sided abdominal pain. Computed tomography (CT) revealed a left ureteral stone and incidentally identified a submucosal gastric tumor and right gastric artery aneurysm, leading to referral to our department. Blood tests showed no abnormalities. CT revealed a 23-mm submucosal tumor protruding outward from the middle gastric body wall. A 13-mm aneurysm was observed in the right gastric artery, and no other aneurysms were detected, including intracranially. Upper gastrointestinal endoscopy revealed a smooth elevation covered by normal mucosa in the middle gastric body. Endoscopic ultrasound-fine needle aspiration resulted in a diagnosis of gastrointestinal stromal tumor (GIST) and surgery. We performed simultaneous surgery involving laparoscopic local resection of the gastric GIST and identification and excision of the right gastric artery aneurysm due to its enlargement (7 mm on CT conducted six years ago). The patient's postoperative course was uneventful, and he was discharged on postoperative day 6. Pathological examination confirmed a diagnosis of segmental arterial mediolysis. DISCUSSION: Intra-abdominal arterial aneurysms affect approximately 1 % of the population. Splenic artery aneurysms are the most common at 58.7 %, whereas the gastric artery and gastroepiploic artery account for only 4.7 %. CONCLUSION: Right gastric artery aneurysms are exceedingly rare, with no reported cases of successful resection before rupture.

Thoracoscopic esophagectomy with subcarinal lymph node dissection in the prone position for esophageal cancer with a right top pulmonary vein.

The right top pulmonary vein (RTPV), a rare pulmonary vein (PV) variant draining the right upper lobe, arises independently from the right superior PV, travels posterior to the right bronchial tree and drains directly into the left atrium (LA) or another PV. We report an RTPV discovered on preoperative computed tomography (CT) scanning in a 60-y-old man who subsequently underwent prone thoracoscopic esophagectomy and subcarinal lymph node dissection. The preoperative CT scan showed an anomalous vessel 7.8 mm in diameter arising from the right upper lobe, running posterior to the right main bronchus (RMB), and draining directly into the LA. To our best knowledge, this is the largest reported RTPV (7.8 mm in diameter) and is an extremely rare variant, passing posterior to the RMB and draining into the LA.