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

Abstract

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.

Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children

“…In 2019, a couple of studies investigated ICG-use for the vascular perfusion of the esophageal esophagus during a laparoscopic resection of an esophageal duplication cyst [ 20 ] and the blood supply of the stapler line of the stomach during a modified sleeve gastrectomy, combined with a laparoscopic Rossetti fundoplication [ 21 ]. More recently, ICG has also been reported for the assessment of the gastric remnant’s blood supply after distal gastrectomy for an early gastric cancer [ 22 ] and for the identification of residual muscle fibers during robotic Heller-Dor procedures for esophageal achalasia [ 23 ].…”

Indocyanine Green-Enhanced Fluorescence-Guided Surgery: Lymphatic Navigation, Perfusion Evaluation and Future Perspectives

“…It is helpful for the surgeon not only to identify node stations but also to better discriminate the borders of the dissection, enhancing the recognition of vascular structures and other organs. In the treatment of achalasia, ICG-guided assessment of the mucosal layer after myotomy during a robot-assisted Heller-Dor procedure has been recently reported to exclude iatrogenic microperforations intraoperatively, but also to visualize ischemic areas caused by monopolar diathermy, which may develop into delayed esophageal perforations with life-threatening consequences [27]. This technique may have relevant potential advantages over intraoperative endoscopy.…”