Summary
Trans-oral, stapled diverticulostomy is the standard-of-care approach for symptomatic Zenker’s diverticulum (ZD), but the technique — as originally described by Collard et al. in 1993 [1] — came with a compromise: surgeons have to settle for a less than optimal common opening or they had to hand-modify a standard linear stapler anvil to achieve a better result. Stapler modification is less common currently, but it has been replaced by a new compromise of modifying the procedure to account for stapler deficiencies. A stapler built with a shorter, smaller-footprint anvil removes the need for it entirely.
What Is Zenker's Diverticulum?
Zenker’s diverticulum is a pseudodiverticulum caused by dysfunction of the cricopharyngeus (CP) muscle, which allows esophageal mucosa and submucosa to herniate through Killian’s triangle — a point of anatomic weakness in the hypopharyngeal wall just above the CP. Patients may present with dysphagia, obstruction, and regurgitation of undigested food. Management ranges from watchful waiting in minimally symptomatic patients to surgical correction once symptoms interfere with nutrition or quality of life.
Why Trans-Oral Surgery Became the Standard of Care
Trans-oral surgery has changed how ZD is treated — shortening procedure time, lowering complication rates and length of stay, and making correction feasible in higher-risk candidates who might not tolerate an open approach. These techniques are now considered standard of care for managing ZD, supported by a growing body of evidence on their short- and long-term safety and effectiveness [2-4].
Every trans-oral technique shares the same surgical goal: dividing the cricopharyngeus muscle and the wall of the esophagus and diverticulum to open a common channel between the diverticulum and the esophagus, eliminating food trapping and the functional cause of the pouch. One of the most widely used ways to accomplish this is stapler-assisted diverticulostomy — using a surgical stapler to divide the “party wall” and create a single common lumen.
The Compromise
Stapler-assisted diverticulostomy was first described by Collard and colleagues in 1993 [1], using a 30 mm linear cutting stapler that the surgical team modified themselves: sawing off the distal portion of the anvil so the stapler could seat fully in the crotch between the diverticulum and the esophagus and divide the entire common wall. Other authors have since described the same workaround — grinding or cutting down a standard anvil tip to make it fit [4,5].
The reason is straightforward anatomy. More recently, given the risk of stapler modification and advancements in endoscopic devices, surgeons have devised other workarounds, including using a suture to try and gather more tissue into the stapler, a laser or cautery to further divide the septum after stapling (somewhat of a combination stapling and Z-POEM), or even abandoning the trans-oral route and proceeding directly with an open approach. Regardless of how a surgeon addresses these drawbacks, the fact is that they are compromising on the quality of the procedure or adding unnecessary complexity and risk to what should be a straightforward case.
Purpose-Built Instead of Modified: The AEON Short Tip Reload
At Lexington Medical, our AEON linear cutting stapler offers a proprietary Short Tip Reload that eliminates the need for compromise. The Short Tip has 19% less surface area than our Standard Tip and, critically, is shorter — short enough to sit fully inside the diverticulum without the surgeon needing to modify anything, and without the perforation risk that comes from forcing a longer tip into a tight space.
With 100% focus on surgical stapling – we are obsessed with making the right stapler for each critical application.
Why Did Lexington Medical Design a Short Tip Reload?
A better question could be, why haven’t any of the legacy stapler manufacturers made one? At Lexington Medical, we are singularly focused on designing and manufacturing the best and most innovative linear staplers on the market. We believe that patients and surgeons deserve this and shouldn’t have to compromise or settle for “good enough”.
Listening to surgeons and their needs, we realized that a short tipped reload was missing from the surgeon’s armamentarium. Traditional anvils were designed with pointy and long tips, largely for bowel anastomoses. These were designed many decades ago, and, while they still serve their intended purpose, surgery and stapling have advanced significantly since then. Staplers are being used in many situations where the standard tip is just not fit for purpose.
The Lexington Medical Short Tip Reload was born from the unmet needs of surgeons, for use in stapling applications where the standard tip is not the best option, such as ZD surgery. It is also ideal in situations where there is limited access, such as the thoracic cavity or retroperitoneum, where a surgeon can’t see the distal end of the anvil, and further dissection is not practical. Situations like dividing the pancreas in a Whipple procedure or distal pancreatectomy, dividing a pulmonary fissure or emphysematous lung tissue are prime examples of where surgeons have found the Short Tip to be advantageous.
Short Tip
Standard Tip
Curved Tip
The Bottom Line for Surgeons
Zenker’s diverticulum is a good reminder that in surgery, a few millimeters of instrument geometry can determine how a device interacts with the anatomy — and whether a surgeon must compromise to get the case done. A stapler designed for the anatomy from the start removes that compromise before it happens.
If you’re a surgeon doing trans-oral stapling for ZD, this should matter to you. To review the AEON Short Tip Reload’s specifications or request a sample for your next ZD case, contact your Lexington Medical representative.
Key Takeaways
- Zenker’s diverticulum can cause dysphagia, obstruction, and regurgitation by trapping food within a pouch above the cricopharyngeus muscle.
- Trans-oral Zenker’s diverticulum surgery divides the common wall between the pouch and esophagus, creating a shared channel for food passage.
- Standard linear stapler anvils may be too long to reach the base of the diverticulum, requiring procedural workarounds or additional tissue division.
- The AEON™ Short Tip Reload has 19% less tip surface area than the Standard Tip and is designed to fit within confined anatomy.
- Purpose-built stapler geometry may help surgeons complete stapler-assisted diverticulostomy without hand-modifying the anvil or unnecessarily changing the procedure.
Frequently Asked Questions
Because a standard linear stapler anvil is often too long to sit fully inside a small-to-moderate ZD pouch. Since Collard et al. first described stapler-assisted diverticulostomy in 1993, many surgeons have hand-shortened the anvil tip so the device can sit in the crotch between the diverticulum and esophagus and completely divide the common wall. This is less common nowadays and has been largely replaced by other modifications of the procedure as described above.
There are several trans-oral (e.g. Z-POEM, stapled diverticulostomy) and open techniques for management of ZD, and the specific procedure should be tailored to the patient’s anatomy, comorbidities, and the surgeon’s experience. Trans-oral, stapler-assisted diverticulostomy remains an evidence-based, well-supported approach for symptomatic ZD.
It’s a proprietary reload for Lexington Medical’s AEON linear cutting stapler, purpose-built for procedures like ZD repair. Its tip has 19% less surface area than the Standard Tip and is shorter overall, allowing it to sit fully inside the diverticulum without modification.
References
- Collard, J.M., J.B. Otte, and P.J. Kestens, Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg, 1993. 56(3): p. 573–6.
- Ramamurthy, S., et al., Management Strategies for Zenker’s Diverticulum: A Comprehensive Review. J Clin Med, 2025. 14(17).
- Dell’Anna, G., et al., The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review. Diagnostics (Basel), 2024. 14(19).
- Chan, E.G., et al., Transoral Stapling Technique for Zenker’s Diverticulum. Operative Techniques in Thoracic and Cardiovascular Surgery, 2020. 25(3): p. 171–189.
- Richtsmeier, W.J., Myotomy length determinants in endoscopic staple-assisted esophagodiverticulostomy for small Zenker’s diverticula. Ann Otol Rhinol Laryngol, 2005. 114(5): p. 341–6.
