Laparoscopic versus robotic‐assisted Heller myotomy for the treatment of achalasia: A systematic review with meta‐analysis

Xie, Julia; Vatsan, Maansi S; Gangemi, Antonio

doi:10.1002/rcs.2253

Cited by 18 publications

(20 citation statements)

References 39 publications

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“…All patients in our study underwent minimally invasive surgery, either laparoscopic or robotic-assisted. Several retrospective studies have shown equivalent outcomes in comparing LHM and RHM with respect to operative time, complications, and success rates [8]. The length of myotomy in our study was 4-5 cm toward the esophageal side and 2-3 cm toward the stomach.…”

Section: Discussionmentioning

confidence: 52%

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Suman¹,

Varshney²,

Soni³

et al. 2022

Cureus

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BackgroundHeller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. MethodologyThis prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and highresolution manometry (HRM) at the one-year follow-up. ResultsThere was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). ConclusionsThe study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.

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Section: Discussionmentioning

confidence: 52%

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Suman¹,

Varshney²,

Soni³

et al. 2022

Cureus

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“…Compared to laparoscopy, robotic Heller myotomy has been shown to reduce the rate of intraoperative perforations of the oesophageal mucosa, being associated to similar clinical outcomes and operative times 12–15,24 . A very recent systematic review with meta‐analysis (based on a total of 3214 patients) compared the efficacy of robotic and laparoscopic Heller myotomies for EA, confirming the superiority of the robotic approach in terms of safety due to the lower rate of oesophageal perforations 15 .…”

Section: Discussionmentioning

confidence: 91%

“…11 Nowadays, robotic surgery is considered by many to be the gold standard of surgical treatment for symptomatic EA, as it has proven to be safe and effective. [12][13][14][15] The objective of this study is to evaluate the role of intraoperative use of indocyanine green (ICG), as an alternative means to intraoperative endoscopy, to increase the accuracy of myotomy and to evaluate the integrity of the oesophageal mucosa at the end of the procedure.…”

mentioning

confidence: 99%

Robotic Heller‐Dor procedure for oesophageal achalasia: Fluorescence‐guided intraoperative assessment of myotomy. A retrospective single‐centre experience

Romanzi

D’Alba

Campagna

et al. 2022

Robotics Computer Surgery

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Background The robotic Heller‐Dor (RHD) procedure for oesophageal achalasia (EA) is safe and effective. We aim to evaluate the intraoperative use of fluorescence imaging, as an alternative means to intraoperative endoscopy, to assess myotomy at the end of the procedure. Methods Thirty‐four patients affected with EA underwent RHD. The myotomy was assessed intraoperatively by endoscopy in group A (17 patients), and by fluorescence imaging in group B (17 patients). Perioperative and long‐term results were compared. Results In group A, one mucosal tear was identified during intraoperative endoscopy. In group B, indocyanine green (ICG) helped identify residual muscle fibres in three cases. No perforation of the oesophageal mucosa occurred in group B. Conclusions Fluorescence‐imaging improved the identification of residual muscle fibres and made it possible to verify the integrity of the mucosa without the use of intraoperative endoscopy. A significant reduction in operative times has been related to the use of this technique.

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“…These striking technical advantages led to swift adoption of the robotic technology. This approach decreased the risk of open conversion both during complex, technically challenging surgical procedures and in severe conditions involving high risk patients [ 11 , 12 , 13 ]. With the expiration of Intuitive’s original patent, there has been a burgeoning release of newer robotic surgery platforms and companies, like Medtronic’s Hugo ® system, which are making robotic-assisted surgery more accessible than ever.…”

Section: The Advent Of Robotic Surgery: a Mere Technological Innovation Or Something More?mentioning

confidence: 99%

Robotic Surgery: Rediscovering Human Anatomy

Gangemi

Chang

Bernante

et al. 2021

IJERPH

Self Cite

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Since its advent, robotic surgery has redefined the operating room experience. It directly addressed and resolved many of the shortcomings of laparoscopic methods while maintaining a minimally invasive approach that brought benefits in cosmesis and healing for patients but also benefits in ergonomics and precision for surgeons. This new platform has brought with it changes in surgical training and education, principally through the utilization of virtual reality. Accurate depictions of human anatomy seen through augmented reality allow the surgeon-in-training to learn, practice and perfect their skills before they operate on their first patient. However, the anatomical knowledge required for minimally invasive surgery (MIS) is distinct from current methods of dissection and prosection that inherently cater towards open surgery with large cuts and unobstructed field. It is integral that robotic surgeons are also equipped with accurate anatomical information, heralding a new era in which anatomists can work alongside those developing virtual reality technology to create anatomical training curricula for MIS. As the field of surgery and medicine in general moves to include more and more technology, it is only fitting that the building blocks of medical education follow suit and rediscover human anatomy in a modern context.

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Laparoscopic versus robotic‐assisted Heller myotomy for the treatment of achalasia: A systematic review with meta‐analysis

Cited by 18 publications

References 39 publications

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Robotic Heller‐Dor procedure for oesophageal achalasia: Fluorescence‐guided intraoperative assessment of myotomy. A retrospective single‐centre experience

Robotic Surgery: Rediscovering Human Anatomy

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