Robot-assisted laparoscopic heller myotomy using the DaVinci Xi

Abstract

: Definitive therapy for achalasia remains an esophageal myotomy across the gastroesophageal junction (GEJ). Approaches to myotomy include transthoracic and transabdominal techniques, both open and minimally invasive. Advantages of a transabdominal approach include full access to the stomach below the GEJ for complete myotomy, the angle of approach to the myotomy, and fundoplication. The use of the Da Vinci Xi surgical robot (Intuitive Surgical, Sunnyvale, CA, USA) adds some distinct advantages to the laparoscopic approach. These include: (I) a steady camera with high-definition, three-dimensional view of the circumferential muscle fibers, (II) tremor reduction through the robotic console, (III) wristed instruments providing flexibility in angle of approach and dexterity, and (IV) bi-polar energy use for more delicate, precise fiber division without excessive thermal spread. The advantage of bi-polar energy delivery over monopolar cautery cannot be overstated. We describe our approach to DaVinci Xi Robot-assisted laparoscopic modified heller myotomy with anterior partial fundoplication.