[Oesophageal GIST at the left tracheobronchial angle: resection with right-sided VATS]. / GIST des Ösophagus im linken tracheobronchialen Winkel: Resektion mittels rechtsthorakaler VATS.

OBJECTIVE: The vast majority of submucosal oesophageal tumours are leiomyomas. Gastrointestinal stromal tumours (GIST) account for only one percent of all gastrointestinal malignancies, whereby an oesophageal location represents a medical rarity. Although surgical resection is the gold standard, the optimal procedure remains a matter of debate. Conventional oesophageal resection is the most common therapeutic choice to ensure complete removal with an appropriate safety margin and avoid dissemination of neoplastic cells. Anyhow, occasional case reports about enucleation of oesophageal GIST have been published. This video paper for the first time describes the use of right-sided video-assisted thoracoscopic surgery (VATS) as a technique to enucleate an oesophageal GIST within the left tracheobronchial angle. INDICATION: A 68-year-old male patient was evaluated for recurrent haemoptysis and dysphagia and diagnosed with a 1.4 cm sized oesophageal tumour at the left tracheobronchial angle. CT scan showed a submucosal location without signs of invasive growth. After conducting endosonography we suspected a leiomyoma and performed minimally invasive enucleation with right-sided VATS. METHOD: Employing independent lung ventilation the patient was put into a left lateral position. Four trocars were applied. After incision of the mediastinal pleura the tumour was localised with intraoperative gastroscopy and diaphanoscopy. By mobilisation of the oesophagus and transection of the azygous vein it was possible to bluntly dissect the mass from surrounding oesophageal muscular fibres and safely extract it with a specimen bag. After removal of the thoracic drainage on the first postoperative day the patient was discharged the day after. The further course was uneventful. Histological work-up showed a GIST pT1cN0M0 R0 with a Ki-67 index less than 1 % (UICC I). After 10 months of follow-up the patient is recurrence-free and shows no symptoms. CONCLUSION: Enucleation of a locally limited oesophageal GIST by right-sided VATS is a feasible and safe surgical procedure with dramatically reduced invasiveness compared to conventional open oesophageal resections.

Accuracy and feasibility of frameless stereotactic and robot-assisted CT-based puncture in interventional radiology: a comparative phantom study.

PURPOSE: To compare the accuracy of frameless stereotactic and robot-assisted puncture in vitro based on computed tomography (CT) imaging with a slice thickness of 1, 3, and 5 mm. MATERIALS AND METHODS: 300 punctures were carried out with help of the Atlas aiming device guided by the optical navigation system Stealth Station TREONplus and 150 punctures were guided by the robotic assistance system Innomotion. Conically shaped rods were punctured with Kirschner wires. The accuracy was evaluated on the basis of control CTs by measuring the Euclidean distance between the wire tip and target and the normal distance between the target and wire. RESULTS: With the Stealth Station a mean Euclidean distance of 1.94 +/- 0.912, 2.2 +/- 1.136, and 2.74 +/- 1.166 mm at a slice thickness of 1, 3 and 5 mm, respectively, was reached. The mean normal distance was 1.64 +/- 0.919, 1.84 +/- 1.189, and 2.48 +/- 1.196 mm, respectively. The Innomotion system resulted in a mean Euclidean distance of 1.69 +/- 0.772, 1.91 +/- 0.673, and 2.30 +/- 0.881 mm, respectively, while the mean normal distance was 1.42 +/- 0.78), 1.60 +/- 0.733, and 1.98 +/- 1.002 mm, respectively. A statistical significance between accuracies with both systems with 1 mm and 3 mm slices could not be detected (p > 0.05). At a slice thickness of 5 mm, the robot was significantly more accurate, but not as accurate as when using thinner slices (p < 0.05). The procedure time is longer for the Innomotion system ( 30 vs. 18 min), and the practicability is higher with the Stealth Station. CONCLUSION: The systems yield comparable accuracy. A slice thickness of 3 mm is adequate. Application of both methods in patient treatment can be expected to be safe and reliable.