Background: Epiphrenic esophageal diverticulum is a rare condition and no world-wide consensus in management. It associates with motility disorder ranged from 60-100%. The diverticulum can be surgically treated by transabdominal, transthoracic, or double approach, depends on the patient status, the diverticular location, size, the associated disorder, and the surgeon's experience. Nowadays, minimally-invasive surgery is the preferred treatment that the robotic approach has been used increasingly. Objective: To demonstrate the techniques of robotic transthoracic esophageal diverticulectomy with myotomy.

Materials: a 53-year-old male with intermittent dysphagia and regurgitation of undigested food for 5 years. EGD and CT scan showed a 12.5-cm-bilobulated diverticulum arising in right hemithorax. The upper border was 1.5 cm below carina. Jackhammer's esophagus was diagnosed by HRM. The video contained the operative room setup, port sites, and the step-by-step procedures, including the crucial anatomy, critical tips, and special considerations.

Results: The patient tolerated the procedure well and postoperative course was uneventful. Operative time was 410 minutes. The esophagography on POD 7 showed no leakage or stricture. Patient can be discharged on POD 10 without reflux symptom or dysphagia within soft diet.

Conclusion: The preoperative workup and planning are important to design the operation in esophageal diverticulum treatment. Thoracoscopic diverticulectomy is preferred in large and high-rising diverticulum. To add myotomy and/or fundoplication routinely is still debated. Selective approach for individual patient is recommended. In MIS era, robotic approach is feasible and effective due to magnified 3-D vision, increase in movement degree, and ability in meticulous dissection.