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

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.

The author has developed an inexpensive model for ESED using a utility latex glove to provide a simulated pharynx with a Zenker's diverticula.

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.

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.

Part of the experience of endoscopic surgery of the pharynx can be gained through an inexpensive simulation of a Zenker's diverticulum.