Carbon dioxide laser diverticulostomy: a new treatment for Zenker diverticulum.

In the United States, the traditional treatment for hypopharyngeal (Zenker) diverticulum has been single-stage transcutaneous diverticulectomy. Complications following this procedure include mediastinitis, vocal cord paralysis, esophageal stenosis, fistula, and recurrent or persistent diverticula. The development of endoscopic equipment has led to a new era of surgery for this condition. Magnification of anatomic landmarks allows for better precision during surgery and reduces both surgical procedure time and postoperative complications. Additional techniques, such as diathermy, bipolar coagulation, stapler, and laser surgery, all of which decrease intraoperative bleeding, lend further support to the procedure. In several randomized controlled clinical trials, endoscopic laser treatment of diverticulum has demonstrated the best results in terms of decreased morbidity and fewer complications. Thus, laser approaches for treating Zenker diverticulum deserve consideration.