Robotic-assisted excision of an infected duplication cyst of the esophagus

Duplication cysts are rare congenital anomalies, most commonly diagnosed during infancy that may occur anywhere along the alimentary tract. Esophageal duplication cysts are frequently symptomatic because of compression of adjacent structures. Here, we discuss the case of a 64-year-old woman with an esophageal duplication cyst leading to progressive and worsening dysphagia. This cyst was identified in the distal esophagus via endoscopic ultrasound (EUS). Biopsy was performed and this resulted in a superimposed infection. The patient presented to our hospital with fevers and dysphagia. She was admitted after a complete history, physical exam and labs were obtained. A computed tomography scan of the chest, abdomen and pelvis was performed along with an esophagogastroduodenoscopy and EUS for further characterization of the cyst. After diagnosing her with a symptomatic duplication cyst of the esophagus, she was consented for surgical intervention. Here, we describe our operative approach of a robotic-assisted esophageal myotomy, duplication cyst excision and gastropexy through an abdominal approach. Postoperatively, the patient underwent an esophagram on post-operative day 5 that demonstrated an intact repair without stricture or leak. She was started on a full liquid diet at that time and discharged from the hospital on post-operative day 6. Symptomatic esophageal duplication cysts often require surgical resection. Generally, we recommend against needle biopsies due to the risk of infection. Our patient presented with an infected esophageal duplication cyst after EUS with biopsies was performed. Here, we present our transabdominal surgical technique using the robotic platform.