Robotic Heller Myotomy
DOI: 10.54647/cm321234 33 Downloads 262599 Views
Author(s)
Abstract
Achalasia is an esophageal motor disorder characterized by the failure of the lower esophageal sphincter (LES) to relax and the loss of peristalsis in the esophageal body. Treatment options aim to alleviate the elevated pressure of the LES and include direct botulinum toxin injection, pneumatic dilation, per-oral endoscopic myotomy (POEM), and Heller myotomy.
Traditionally, laparoscopic Heller myotomy with partial fundoplication has been the gold standard for treating achalasia. However, the robotic approach is gaining popularity for foregut operations. The robotic system facilitates an extended esophageal mediastinal dissection further up into the chest. It also offers excellent visualization of the esophageal layers, resulting in a smoother and safer myotomy.
The addition of a partial fundoplication, whether anterior or posterior, to Heller myotomy significantly reduces the risk of esophageal reflux. This risk decreases from approximately 50% without a fundoplication to less than 10% with a partial fundoplication. The robotic technique, with its enhanced precision and visualization, represents a promising advancement in the management of achalasia.
Keywords
Robotic Heller Myotomy
Cite this paper
Marina Gabrielle Epstein, Gabriel Garbato, Gabriel Maccapani, Camille Diem Benatti, Ivan Carlos Batista, Luis Henrique Barreto Chaves, Amanda Domit Dall'Alba,
Robotic Heller Myotomy
, SCIREA Journal of Clinical Medicine.
Volume 9, Issue 1, February 2024 | PP. 21-26.
10.54647/cm321234
References
[ 1 ] | Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med. 2019;381:2219-29. |
[ 2 ] | Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807-16. |
[ 3 ] | Kaaki S, Hartwig MG. Robotic Heller myotomy and Dor fundoplication: Twelve steps. JTCVS Tech. 2022 Aug 20;16:163-168. doi: 10.1016/j.xjtc.2022.07.028. PMID: 36510514; PMCID: PMC9735328. |
[ 4 ] | Huffmanm LC, Pandalai PK, Boulton BJ, James L, Starnes SL, Reed MF, Howington JA, Nussbaum MS. Robotic Heller myotomy: a safe operation with higher postoperative quality-of-life indices. Surgery. 2007 Oct;142(4):613-8; discussion 618-20. doi: 10.1016/j.surg.2007.08.003. PMID: 17950356. |
[ 5 ] | Sollie ZW, Jiwani AZ, Wei B. Robotic Heller myotomy. Mini-invasive Surg 2020;4:80. http://dx.doi.org/10.20517/2574-1225.2020.81 |
[ 6 ] | Allaix ME, Patti MG. Heller myotomy for achalasia. From the open to the laparoscopic approach. World J Surg 2015;39:1603-7. |
[ 7 ] | Kim SS, Guillen-Rodriguez J, Little AG. Optimal surgical intervention for achalasia: laparoscopic or robotic approach. J Robot Surg 2019;13:397-400. |
[ 8 ] | Ali AB, Khan NA, Nguyen DT, et al. Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. Surg Endosc 2020;34:3191-6. |
[ 9 ] | Khashab MA, Kumbhari V, Tieu AH, et al. Peroral endoscopic myotomy achieves similar clinical response but incurs lesser charges compared to robotic heller myotomy. Saudi J Gastroenterol 2017;23:91-6. |