Totally robotic enucleation of a mid-esophageal leiomyoma

Enucleation of an esophageal leiomyoma is the treatment of choice in symptomatic patients. Several open or minimally invasive approaches have been shown to be safe and effective. Robotic approaches allow for delicate and precise dissection with improved three-dimensional visualization. The robotic operative technique for enucleation has not been well described. In this context, we present the case of a 53-year-old obese man struggling with dysphagia and odynophagia due to a mid-esophageal leiomyoma. In the case presentation, we review the preoperative workup with high-quality images, robotic port placement, equipment needed, intraoperative conduct, and postoperative course. We provide a step-by-step video tutorial encompassing the preoperative workup, operative steps, tips and tricks, and postoperative course using a totally robotic enucleation of a 7-cm mid-esophageal leiomyoma. This case presentation can serve as a comprehensive teaching case for trainees and a high-quality example of the conduct of the operation for practicing surgeons, including some tips and tricks for optimal results. We also highlight that an assistant port is not required.