A key component of the surgical approach is division of the cricopharyngeus. If the pouch is small, resection might not even be necessary. This relatively small pouch is being held with a Babcock clamp while the myotomy is performed.
The adequate myotomy is shown prior to resection of the sac, which is performed with a stapler. A more recent approach is transoral endoscopic linear stapling. The stapler both divides the cricopharyngeus and widens the opening between pouch and esophagus allowing food to empty properly.
The brachiocephalic artery crosses the substernal portion of the trachea diagonally. There it is subject to catastrophic erosion from the tip of an improperly placed tracheostomy tube. The recent advent of endoscopic-guided percutaneous tracheostomy is a quicker alternative to traditional open surgical tracheostomy. Bleeding from the thyroid isthmus and its veins is a potential complication of this method.