Application of methylene blue staining for precise positioning of small esophageal leiomyoma during video-assisted thoracoscopic surgery via one utility port_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Zheng ^1,2 ,  LIAO Yongde ¹ , LI Kuo ¹ , HUANG Quanfu ¹ , LIU Mei ³ , FU Xiangning ¹

1. Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, 430030, P.R.China;
2. Department of Thoracic Surgery, Yuhuangding Hospital, Qingdao University Medical School, Yantai, 264000, Shandong, P.R.China;
3. Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, 430030, P.R.China;

Corresponding author：

LIAO Yongde, Email: liaotjxw@126.com

Keywords：

Esophageal leiomyomas; methylene blue; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201709053

Video：

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Objective To develop a novel methylene blue staining technique to localize small esophageal leiomyomas (<1.5 cm) and evaluate its feasibility. Methods Between January 2013 and October 2016, 9 patients with small esophageal leiomyomas (<1.5 cm) underwent thoracoscopic enucleation in Tongji Hospital. There were 5 males and 4 females with an average age of 51 years. We preoperatively injected 0.5–1.0 ml methylene blue in the submucosa adjacent to the tumors under the guidance of gastroscope. Then, we transferred the patients to the operating room. Results Staining was successful in 9 patients. The unstained tumor was exposed after the blue-stained mediastinal pleura and overlying muscle were incised longitudinally during video-assisted thoracoscopic surgery via one utility port. No abnormalities were detected in the esophageal mucosa. No major complications, such as esophageal leakage or esophageal diverticulum occurred. Conclusion Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during video-assisted thoracoscopic surgery via one utility port. This method will enable enucleation precise and easy.

Citation： ZHANG Zheng, LIAO Yongde, LI Kuo, HUANG Quanfu, LIU Mei, FU Xiangning. Application of methylene blue staining for precise positioning of small esophageal leiomyoma during video-assisted thoracoscopic surgery via one utility port. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 795-798. doi: 10.7507/1007-4848.201709053 Copy

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2.	Bardini R, Segalin A, Ruol A, et al. Videothoracoscopic enucleation of esophageal leiomyoma. Ann Thorac Surg, 1992, 54(3): 576-577.
3.	Everitt NJ, Glinatsis M, McMahon MJ. Thoracoscopic enucleation of leiomyoma of the oesophagus. Br J Surg, 1992, 79(7): 643.
4.	Priego P, Lobo E, Alonso N, et al. Surgical treatment of esophageal leiomyoma: an analysis of our experience. Rev Esp Enferm Dig, 2006, 98(5): 350-358.
5.	von Rahden BH, Stein HJ, Feussner H, et al. Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc, 2004, 18(6): 924-930.
6.	Kent M, d'Amato T, Nordman C, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg, 2007, 134(1): 176-181.
7.	Zaninotto G, Portale G, Costantini M, et al. Minimally invasive enucleation of esophageal leiomyoma. Surg Endosc, 2006, 20(12): 1904-1908.
8.	Shin S, Choi YS, Shim YM, et al. Enucleation of esophageal submucosal tumors: a single institution's experience. Ann Thorac Surg, 2014, 97(2): 454-459.
9.	Xu GQ, Qian JJ, Chen MH, et al. Endoscopic ultrasonography for the diagnosis and selecting treatment of esophageal leiomyoma. J Gastroenterol Hepatol, 2012, 27(3): 521-525.
10.	Choi SH, Kim YT, Han KN, et al. Surgical management of the esophageal leiomyoma: lessons from a retrospective review. Dis Esophagus, 2011, 24(5): 325-329.
11.	Jiang G, Zhao H, Yang F, et al. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus, 2009, 22(3): 279-283.
12.	Luh SP, Hou SM, Fang CC, et al. Video-thoracoscopic enucleation of esophageal leiomyoma. World J Surg Oncol, 2012, 10: 52.
13.	Jeon HW, Choi MG, Lim CH, et al. Intraoperative esophagoscopy provides accuracy and safety in video-assisted thoracoscopic enucleation of benign esophageal submucosal tumors. Dis Esophagus, 2015, 28(5): 437-441.
14.	Claus CM, Cury Filho AM, Boscardim PC, et al. Thoracoscopic enucleation of esophageal leiomyoma in prone position and single lumen endotracheal intubation. Surg Endosc, 2013, 27(9): 3364-3369.
15.	Argote-Greene LM, Martin-Del-Campo LA, Torres-Villalobos G, et al. Enucleation of esophageal leiomyoma by video-assisted thoracic surgery. Multimed Man Cardiothorac Surg, 2010, 2010(1014): mmcts.2008.003467.

1. Mutrie CJ, Donahue DM, Wain JC, et al. Esophageal leiomyoma: a 40-year experience. Ann Thorac Surg, 2005, 79(4): 1122-1125.
2. Bardini R, Segalin A, Ruol A, et al. Videothoracoscopic enucleation of esophageal leiomyoma. Ann Thorac Surg, 1992, 54(3): 576-577.
3. Everitt NJ, Glinatsis M, McMahon MJ. Thoracoscopic enucleation of leiomyoma of the oesophagus. Br J Surg, 1992, 79(7): 643.
4. Priego P, Lobo E, Alonso N, et al. Surgical treatment of esophageal leiomyoma: an analysis of our experience. Rev Esp Enferm Dig, 2006, 98(5): 350-358.
5. von Rahden BH, Stein HJ, Feussner H, et al. Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc, 2004, 18(6): 924-930.
6. Kent M, d'Amato T, Nordman C, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg, 2007, 134(1): 176-181.
7. Zaninotto G, Portale G, Costantini M, et al. Minimally invasive enucleation of esophageal leiomyoma. Surg Endosc, 2006, 20(12): 1904-1908.
8. Shin S, Choi YS, Shim YM, et al. Enucleation of esophageal submucosal tumors: a single institution's experience. Ann Thorac Surg, 2014, 97(2): 454-459.
9. Xu GQ, Qian JJ, Chen MH, et al. Endoscopic ultrasonography for the diagnosis and selecting treatment of esophageal leiomyoma. J Gastroenterol Hepatol, 2012, 27(3): 521-525.
10. Choi SH, Kim YT, Han KN, et al. Surgical management of the esophageal leiomyoma: lessons from a retrospective review. Dis Esophagus, 2011, 24(5): 325-329.
11. Jiang G, Zhao H, Yang F, et al. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus, 2009, 22(3): 279-283.
12. Luh SP, Hou SM, Fang CC, et al. Video-thoracoscopic enucleation of esophageal leiomyoma. World J Surg Oncol, 2012, 10: 52.
13. Jeon HW, Choi MG, Lim CH, et al. Intraoperative esophagoscopy provides accuracy and safety in video-assisted thoracoscopic enucleation of benign esophageal submucosal tumors. Dis Esophagus, 2015, 28(5): 437-441.
14. Claus CM, Cury Filho AM, Boscardim PC, et al. Thoracoscopic enucleation of esophageal leiomyoma in prone position and single lumen endotracheal intubation. Surg Endosc, 2013, 27(9): 3364-3369.
15. Argote-Greene LM, Martin-Del-Campo LA, Torres-Villalobos G, et al. Enucleation of esophageal leiomyoma by video-assisted thoracic surgery. Multimed Man Cardiothorac Surg, 2010, 2010(1014): mmcts.2008.003467.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of methylene blue staining for precise positioning of small esophageal leiomyoma during video-assisted thoracoscopic surgery via one utility port

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