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Biomedical subjects

William J Richtsmeier

Publications and source records attributed to William J Richtsmeier.

5 recordsLinked to original sources
PubMed2003

Endoscopic management of Zenker diverticulum: the staple-assisted approach.

Hypopharyngeal (Zenker) diverticulum is a physiologic obstruction of the esophageal entroitus due, at least in part, to reflux irritation. Endoscopic techniques have largely replaced the traditional treatment, comprising external excision and myotomy. In this article, the classic Dohlman technique is compared with the newer endoscopic staple-assisted esophagodiverticulostomy, which provides an endoscopic approach to Zenker diverticulum-associated dysphasia. This technique can be practiced with a simulator, requires little experience, has a good safety record, and has acceptable results.

Esophagoscopy↗
PubMed2002

Postendoscopic Zenker esophagodiverticulostomy leaks associated with a specific stapler cartridge.

OBJECTIVE: To determine the cause of postoperative leaks in 2 patients with Zenker diverticula treated with endoscopic staple-assisted esophagodiverticulostomy. DESIGN: Medical chart review and simulated surgery. SETTING: Teaching hospital. PATIENTS AND METHODS: Two case reports of postoperative leaks in patients treated with endoscopic staple-assisted esophagodiverticulostomy and experimental simulated surgery to investigate the possible cause of this complication. Use of a TR45B, 3.5-mm cartridge for an Endopath ETS Flex45 Endoscopic Articulation Linear Cutter stapler was associated with complications, whereas use of a TR45W, 2.5-mm cartridge in the same stapler was not. RESULTS: In a simulated surgery model, the 3.5-mm cartridge staple line leaked from the incision apex with pressure of less than 20 cm H(2)O, whereas the apex remained dry when using the 2.5-mm cartridge. When pressure was increased to 30 cm H(2)O, the staple line of the 2.5-mm cartridge had diffuse weeping of fluid but no focal, apical leak. CONCLUSIONS: Endoscopic staple-assisted esophagodiverticulostomy continues to be a relatively safe procedure; however, to provide maximum safety at the apex, the surgeon needs to be aware of stapler cartridge differences.

Aged↗
PubMed2002

Simulated Zenker's endoscopic staple-assisted esophagodiverticulostomy (ESED) surgery.

PURPOSE: The process of learning new surgical procedures remains a challenge in otolaryngology-head and neck (OHN) surgery. Endoscopic surgery for Zenker's diverticulum presents a dilemma mandating simulated surgery because there is no animal model or cadaver situation resembling the pathologic condition. STUDY DESIGN: The author has developed an inexpensive model for ESED using a utility latex glove to provide a simulated pharynx with a Zenker's diverticula. METHODS: First, the thumb and index finger are isolated with a staple line and a rubber band is placed around the long and ring fingers to simulate the cricopharyngeus muscle. The long finger, which will act as the larynx, is cannulated with a noncompressible endotracheal tube. The ring finger then simulates the esophagus and the little finger, the Zenker's diverticular pouch. The glove and the endotracheal tube are positioned inside a 1-ft length of 3-in polyvinyl chloride (PVC) pipe. A bivalving laryngoscope is suspended to visualize the "postcricoid area" and the parting wall. The rubber band pulls the inferior aspect of the "esophagus" up against the "larynx," simulating the tight cricopharyngeal segment. Using video-telescopic control, the endoscopic stapler is used in the standard fashion as described for ESED. RESULTS: This model provides an opportunity for OHN surgeons to become familiar with endoscopic stapling and suturing devices, and experience the difficulty of using long telescopes, suspension laryngoscopes, and staplers in a confined area. CONCLUSION: Part of the experience of endoscopic surgery of the pharynx can be gained through an inexpensive simulation of a Zenker's diverticulum.

Digestive System Surgical Procedures↗