177: A 5-YEAR SINGLE CENTER EXPERIENCE IN ROBOTIC SURGERY FOR ESOPHAGEAL ACHALASIA IN A TERTIARY CENTER, WITH PERI-OPERATIVE TAILORED PROTOCOLS

Abstract

Abstract Background and aim Esophageal achalasia is a rare benign disease with heavy impact on daily life. Laparoscopic Heller-myotomy as the gold standard surgical treatment. In recent years the robot-assisted (DaVinci, Intuitive Surgical Inc., CA) technique became widely used for its reported advantages in terms of vision, precision and motion. The aim of the study was to evaluate the supposed advantages of robot-assisted Heller myotomy compared to the standard laparoscopic approach in a single center experience. Methods We included the patients who underwent standard laparoscopic and robot-assisted Heller-myotomy with Dor fundoplicatio in the last 5 years in the Upper-GI division of the University Hospital of Verona. We assessed if the robot-assisted Heller-Dor myotomy was simplified in terms of the ease of the myotomy, especially on the gastric side and the following fundoplicatio, on the sharpness of the endoscope and on the precision of the movements. We also compared the operative times with the two techniques, and the overall morbidity and mortality rates, also with the introduction of new peri-operative protocols for standardized and enhanced recovery. Results We included 40 patients who underwent Heller-Dor, robot-assisted Heller-Dor approach was performed in 17 patients and standard laparoscopic approach in 23 patients. Based on the surgeons experience and judgment, robot-assisted Heller-myotomy seems to be easier than the laparoscopic procedure in terms of sharpness of vision, freedom of motion and consequently precision in the single-fibers dissection of the muscularis. The operative times were comparable between the robot-assisted procedures and the laparoscopic approach, as were morbidity and mortality rates; in-hospital stay was also similar in the two groups, with a slight decrease in the last 6 months, after the introduction of new post-operative protocols for enhanced recovery with mandatory contrast swallow on POD1. Conclusion Our study suggests that robot-assisted Heller-myotomy for achalasia is a valid alternative to the traditional laparoscopic approach, for the improvement of surgical precision and myotomy outcome, with apparently no deterioration of safety and surgical complications, in particular with dedicate personnel and standardized recovery protocols. It also suggests that the learning curve is negligible if supported by an adequate number of patients per-year, as in a tertiary center.