RT Book, Section A1 Hunter, John G. A1 Spight, Donn H. A1 Sandone, Corinne A1 Fairman, Jennifer E. SR Print(0) ID 1162529952 T1 Transoral Cricopharyngeal Myotomy and Zenker Diverticulectomy T2 Atlas of Minimally Invasive Surgical Operations YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9780071449052 LK accesssurgery.mhmedical.com/content.aspx?aid=1162529952 RD 2024/03/28 AB A Zenker diverticulum is a pulsion diverticulum that occurs between the cricopharyngeus muscle inferiorly and the inferior constrictor superiorly as a result of relative obstruction to swallowing at the esophageal introitus by a “tight” cricopharyngeus muscle (Figure 1A). As the diverticulum develops and extends inferiorly and posteriorly, the cricopharyngeus muscle is enveloped by mucosa from the posterior wall of the esophageal introitus and the anterior wall of the diverticulum (Figure 1B). This relationship allows transoral division of the common wall between the esophagus and diverticulum, and cricopharyngeal myotomy with a single firing of a linear stapler inserted into the diverticulum (one jaw) and across the upper esophageal sphincter (cricopharyngeus muscle) (Figure 1C). An important anatomic fact that supports the safe performance of the cricopharyngeal myotomy is that the hypopharynx, diverticulum, and cervical esophageal complex are surrounded by the middle layer of the deep cervical fascia, which protects against leakage into the mediastinum.