INTRODUCTION: Esophageal leiomyomas are infrequent intramural benign tumors of the esophagus. Resection is the mainstay of treatment in symptomatic patients. We present a case video and the surgical technique of esophageal leiomyoma enucleation using a robotic-assisted transabdominal approach.

METHODS: A 42-year-old male presented with dysphagia, odynophagia, and regurgitation. Endoscopy and ultrasound demonstrated a lobulated 2 cm submucosal mass near the gastrointestinal junction (GEJ) arising from the muscularis propria. The patient was scheduled for minimally-invasive transabdominal surgical resection using the da Vinci® Xi robot. He was placed in supine position and endoscopy identified the submucosal mass at the GEJ. The abdomen was entered laparoscopically. Six ports were placed under direct visualization and a self-retaining liver retractor was used. The robot was docked. Dissection proceeded to separate the anterior and lateral distal esophagus from the hiatus. Endoscopy was performed to localize the tumor to the left of the GEJ. The muscularis was incised and the mass was identified, dissected circumferentially, and amputated at its stalk from the underlying muscularis. The underlying mucosa was in tact and the muscularis was reapproximated using interrupted suture. The specimen was removed in a bag and the abdomen was closed.

RESULTS: A postoperative esophagram did not demonstrate esophageal leak and diet was advanced. The patient was discharged on postoperative day 2 on a full liquid diet. Final pathology confirmed leiomyoma.

CONCLUSION: We demonstrated the technique for transabdominal robotic-assisted enucleation of intramural esophageal leiomyoma which is safe and effective.