Anatomy:

1) Cartilago thyroidea

2) M. constrictor pharyngis inferior

3) M. arytenoidus

4) M. cricothyroideus

5) Trachea

6) N. laryngeus inferior

7) Oesophagus

8) Zenker’s diverticulum.

The approach is on the left anterior line of the sterno-cleido-mastoid muscle. The internal jugular vein is posteriorly retracted and the left thyroid lobe anteriorly. The inferior thyroid artery is often ligated. The omohyoid muscle is retracted or sectioned. The inferior laryngeal nerve, if visible, is carefully retracted anteriorly.

At the uper part of the incision the Zenker’s diverticulum is repaired. It often is in close contact with the esophageal wall and has contracted fibrous adhesions with it. The diverticulum is progressively elevated from its fundus to its base and thus dissected free from the esophagus…

…until the cricothyroid muscle is exposed. The base of the diverticulum is now visualized.

A gastric tube is inserted by the anesthetist. The linear stapler is applied on the base of the diverticulum. Before firing the device the finger of the operator pushes on the tube and esophagus to prevent a stenotic stapling.

The cricothyroid muscle is transversally sectioned and neighbouring longitudinal esophageal musculature is extramucosally splitted apart.

A methylene blue test can be done and the esophageal muscular fibers are left opened. A flat drain is applied in the vicinity of the stapling.