VA03.1. Robotic Enucleation of Middle Esophageal Leiomyoma Without Esophagectomy

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Abstract Topic Benign Disease: Esophageal Surgery Background Esophageal leiomyoma is a benign mesenchymal tumor requiring surgical treatment in symptomatic or large lesions. Although thoracotomy was historically standard, minimally invasive thoracoscopic techniques became preferred. However, middle esophageal tumors remain technically demanding. Robotic assistance was selected to enable precise enucleation while preserving mucosal integrity and minimizing perforation risk. Methods A patient was referred for evaluation of a subepithelial lesion in the middle esophagus presented as a right lateral wall bulge with intact mucosa and preserved luminal distensibility. Contrast-enhanced computed tomography demonstrated a well-defined solid mass of 6.3 cm, without lymphadenopathy or local invasion. Subsequent endoscopic ultrasound confirmed it to be a homogeneous hypoechoic lesion in muscularis propria. Finally, fine-needle aspiration biopsy revealed a mesenchymal spindle cell neoplasm, with immunohistochemistry positive for desmin and smooth muscle actin and negative for CD117 DOG-1 therefore, confirming the diagnosis of leiomyoma. Given tumor size and location, robotic-assisted thoracoscopic enucleation was indicated. After right-sided port placement and robotic docking, the parietal pleura was opened to expose the thoracic esophagus. A longitudinal myotomy allowed careful capsular dissection with strict mucosal preservation.The muscular layer was closed after complete tumor enucleation and hemostasis confirmation. A right-sided pigtail chest drain was placed at the end of the procedure. Results The procedure was completed successfully using a minimally invasive approach, ,without conversion to open surgery or need for esophagectomy. Total operative time was 90 minutes. Intraoperative blood loss was minimal, and no transfusion was required. There were no intraoperative or postoperative complications. The postoperative course was uneventful, with early initiation of oral intake and good dietary tolerance. The patient remained clinically stable and was discharged on postoperative day two. During outpatient follow-up, she remained asymptomatic, with no evidence of late complications or tumor recurrence at the time of the last evaluation. Conclusion This case demonstrates that individualized surgical planning is fundamental in the management of esophageal leiomyoma. Robotic minimally invasive enucleation enabled complete tumor removal without the need for esophagectomy. The patient experienced no complications and a short hospital stay. In the context of a relatively rare condition and limited robotic data, these findings reinforce a tissue- and organ-preserving strategy as a safe and clinically meaningful approach for optimizing postoperative recovery and surgical outcomes.

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