Combined dissector for laparoscopic esophageal myotomy: introduction of a prototype of dedicated instrumentation

The authors' aim in this article is to present the use of a combined dissector, devised, designed and patented by themselves, for laparoscopic oesophageal myomectomy in achalasic patients. The prototype was produced by Karl Storz Endoskope. This tool has a stem measuring 10 mm in diameter, with an operative push rod consisting of two upward bent jaws and an electrode that can emerge from the jaws as required by the surgeon. The authors used the dissector in two patients with a surgical achalasic mega-oesophagus. The two jaws can dissect and then divide the oesophageal muscular layer from the submucosal layer, whereas the electrode can cut the muscular fibres. The use of the combined dissector allows the surgeon to perform oesophageal myomectomy easily, with efficacy and safety, using only the right hand. The instrument requires a number of minor changes which are currently being planned.