Harmonic scalpel in the treatment of Zenker's diverticulum

Objectives/Hypothesis: To describe the transoral treatment of Zenker's diverticulum with a harmonic scalpel and review the initial outcomes of patients treated with this technique. Study Design and Methods: Retrospective study of 25 patients with symptomatic Zenker's diverticula who were treated endoscopically with the harmonic scalpel (Ethicon Endo-Surgery, Inc, Cincinnati, OH). Electronic medical records were reviewed. Extracted data included outpatient clinic notes, operative reports, hospital summaries, and follow-up visits. Results: All identified patients (N=25) were treated successfully and safely with the harmonic scalpel. All patients were observed overnight, and 21 (84%) were dismissed the day after surgery. One patient with a history of cardiac disease had a non-ST-elevation myocardial infarction, one patient had aspiration pneumonia, and two patients had chest pain (both stayed for complete evaluations with negative findings). One patient had subcutaneous emphysema. No patients had hemorrhage, infection, mediastinitis, or death in the postoperative period. The average length of follow-up was 10.3 months. One patient had a recurrent diverticulum that was treated with an open surgical technique. Conclusions: Various treatment options are available for Zenker's diverticulum. There has been a trend toward less invasive techniques, and the harmonic scalpel is one useful treatment option. This review demonstrates that the harmonic scalpel is a safe and effective alternative. Longer follow-up time is needed to assess long-term success and incidence of recurrence with this new technique.