Robot-Assisted Laparoscopic Heller Cardiomyotomy: Preliminary UK Results

Abstract

Background/Aim: Laparoscopic Heller cardiomyotomy is an established modality in the surgical treatment of patients having achalasia cardia. We present our initial experience in robot-assisted laparoscopic Heller cardiomyotomy without addition of an antireflux procedure and discuss the relative merits and disadvantages of the procedure. Patients and Methods: Five patients underwent robot-assisted laparoscopic Heller cardiomyotomy between August 2001 and October 2002. The diagnosis had been confirmed by radiology and manometry in all patients prior to surgery. Results: All procedures were completed successfully using the robotic system, without conversion to open procedure. Mucosal perforation occurred in 1 patient and was sutured robotically. The average operative time was 114.8 (range 65–160) min which is comparable to laparoscopic procedures. After a mean follow-up period of 9.4 (range 3–17) months, 4 patients remained completely asymptomatic, and 1 patient has benefited from symptomatic improvement. Conclusions: The enhanced dexterity and the high-quality three-dimensional vision available with robot-assisted surgery make the application of this technology highly suitable for Heller cardiomyotomy. The minimal lateral and posterior dissection due to the wristed instruments avoids the need for an antireflux procedure.