Robotic Heller myotomy

Abstract

Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects motility, causing symptoms such as progressive dysphagia with liquids then solids, heartburn, regurgitation, odynophagia, weight loss, nocturnal cough, and chest pain. Evaluation will show a characteristic "bird's beak" appearance on barium esophagram and diagnosis is confirmed with esophageal manometry. Durable relief from the symptoms of achalasia can be achieved with pneumatic dilation, per-oral endoscopic myotomy, or surgical myotomy. Laparoscopic Heller myotomy with Dor (or Toupet) fundoplication for many years had been considered the gold standard for therapy. Since its development in 2001, the robotic Heller myotomy (RHM) has gained increasing popularity. Studies have shown equivalent efficacy of relieving achalasia symptoms but decreased incidence of esophageal perforation with RHM. The higher cost of RHM remains the largest barrier. Our objective was to provide a brief review of the current literature related to RHM and provide a detailed description of how to perform the procedure.

Robotic Heller Myotomy

“…The literature places significant emphasis on the rate of esophageal mucosal perforation. Case reports indicate no instances of mucosal perforation, with only one noted in retrospective reviews 5 .…”

“…The hindrance in food progression down the esophagus prompts 60-90% of patients to report regurgitation, leading to aspiration and chronic pulmonary symptoms. Other associated symptoms encompass weight loss, recurrent pneumonia, chronic cough, and heartburn resulting from food and acid stasis 5 .…”