Leiomyomas at the gastroesophgeal junction (GOJ) are rare. Despite their benign nature, these tumours can grow to very large sizes and lead to significant clinical symptoms such as dysphagia and chest pain. Traditional surgical approaches for GOJ leiomyomas, particularly those situated in the mediastinum, often present considerable challenges, with some cases necessitating open surgical techniques or even esophagectomies. Using the robotic approach for these lesions can help to enhance access and visualisation, allowing for effective extramucosal dissection and preservation of the vagal trunks.
We present two cases of patients with symptomatic GOJ leiomyomas who underwent excision using the da Vinci Xi robotic surgical system: First case demonstrates a 65mm lesion associated with a hiatus hernia. The second case demonstrates a 90mm lesion wrapping circumferentially around the GOJ with a posterior pedicle situated deep within the mediastinum. A pre-operative diagnosis of leiomyoma was achieved with endoscopic ultrasound in both cases and the patients underwent extramucosal excision of their lesions followed by re-approximation of the myotomy defect, cruroplasty and anterior fundoplication. Both patients had an uneventful post-operative course and were discharged on day two.