Background: The gold standard for the surgical treatment of Zenker's divert
iculum is diverticulectomy and cricopharyngeal myotomy by an external appro
ach. Unfortunately, many of the patients who present with this entity are e
lderly and have significant comorbidities that increase operative risk. Tra
ditional minimally invasive approaches have not met with widespread success
. However, by combining the exposure afforded by the otolaryngologist's new
er bivalved operating laryngoscopes with the operative techniques made poss
ible by the general surgeon's laparoscopic instrumentation and staplers, it
is possible to achieve reliable and safe endoscopic outpatient management
of this disease entity, with resumption of a normal diet on the same day.
Methods: We reviewed the physiologic basis, instrumentation, and technical
considerations for this endoscopic procedure. We also documented our operat
ive experience with 21 patients treated over an Is-month period.
Results: Successful minimally invasive management of Zenker's diverticulum
was possible in 18 of 21 patients. In two patients, anatomic limitations of
mouth and neck anatomy precluded exposure of the diverticulum; in another
patient, the diverticulum was too small. Small operative perforations of th
e apex of the diverticulum occurred in three cases. Two of these perforatio
ns were repaired primarily with minimally invasive techniques; in the other
case, treatment consisted of observation alone. In all but this last patie
nt, oral diet was resumed on the day of the operation. Eleven of the patien
ts were discharged from the hospital on the same day; the remaining patient
s went home the following morning.
Conclusions: With proper patient selection, minimally invasive management o
f Zenker's diverticulum is a safe and effective surgical technique that all
ows for outpatient management of the majority of patients who present with
this disease.