A 68-year-old male patient complaining of epigastric pain, vomiting and postprandial regurgitation, dysphagia, and heartburn. Over the past three years, there has been progressive dysphagia and worsening of halitosis. The investigation started with an upper digestive endoscopy that showed a sizeable diverticular ostium, full of food waste, just above the gastroesophageal transition. For a better therapeutic plan, a contrasted esophagus-stomach-duodenal radiograph was requested, which corroborated the endoscopy's finding, presenting a sizeable diverticular formation (90.6 x 60.2 cm along the left and anterior lateral contour of the lower third of the esophagus, projecting into the posterior mediastinum. Finally, the postponement was given by a computed tomography scan of the chest, which demonstrated a sizeable diverticular formation in the lateral wall of the distal esophagus, with a large neck (20.4 cm), measuring 70.6 x 60.3 cm, in the axial plane, containing residues forming a level.
A 5 mm trocar was placed next to the xiphoid appendix to open space near the liver. A 12 mm trocar was inserted in the upper right quadrant of the abdomen in the topography of the anterior axillary line. The robotic platform was allocated, allowing the start of docking and surgery. Diverticula of the thoracic esophagus measured approximately 7 cm long and 3 cm in diameter by endoscopy. For access to the thoracic cavity was required dissection of this hiatus hernia and lysis of adhesions of the robotic arm. The diverticula approach was made by using endoscopy to empty the content and make the dissection of the cavity easier. We proceeded with the partial opening of the esophageal pillar for better closure of the diverticulum ostium and the esophageal diverticulectomy stapling with three purple loads from the universal automatic stapler iDrive Ultra, associated with esophageal myotomy. (Figure 1)
Histopathological examination revealed an esophageal end segment measuring 7 cm long and 3 cm in diameter with irregular muscle subepithelial layer and extensive hemorrhage. The patient's postoperative evaluation was standard, without any complication, and was discharge from the hospital on the fourth day post-surgery.