Zenkers diverticulum

Repair of pharyngo-oesophageal diverticulum
1.Position the patient supine on a head ring facing the right side with a sandbag between the shoulder blades.
2.Make an incision along the anterior border of the SCM for a variable distance depending on the size of the diverticulum, through skin and platysma.
3.Free the anterior border of SCM, retracting it laterally and divide the omohyoid muscle.
4.Continue dissection in the plane between the SCM and the thyroid medially and ligate the middle thyroid veins as they are usually in the way.
5.Identify the ITA and RLN, and then ligate the ITA (usually necessary).
6.Grasp the fundus of the diverticulum and dissect down to its neck using sharp dissection.
7.There may be some fibrous tissue at the neck of the diverticulum, divide these to visualize the fibres of crico-pharyngeus.
8.Insert a right angled clamp between the mucosa and the crico-pharyngeus to perform a cricomyotomy using diathermy for a distance of 5-6cm.
9.With the mucosa bulging, apply and fire a TA30 stapler across the neck of the diverticulum, amputate the diverticulum.
10.Ensure haemostasis and close in layers.

PS For endoscopic stapling use Collard 93 stapling device.