Robotic Heller myotomy

Zachary W Sollie,Benjamin Wei,Alisha Z Jiwani

doi:10.20517/2574-1225.2020.81

Zachary W Sollie, Benjamin Wei + Show 1 more

Open Access

https://doi.org/10.20517/2574-1225.2020.81

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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.

Highlights

Achalasia is a neurodegenerative disorder of the esophagus characterized by failure of the lower esophageal sphincter (LES) to relax and decrease or absence of esophageal body peristalsis[1,2,3]
robotic Heller myotomy (RHM) with Dor fundoplication is an extremely safe and effective procedure for relieving symptoms of esophageal achalasia. Use of this approach is associated with almost no complications related to esophageal perforations
Enhanced 3-D visualization and increased mobility of surgical instruments provide surgeons with superior dexterity for performance of intricate movements required for the dissection of the lower esophageal sphincter

Summary

Introduction

Achalasia is a neurodegenerative disorder of the esophagus characterized by failure of the lower esophageal sphincter (LES) to relax and decrease or absence of esophageal body peristalsis[1,2,3]. The incidence has variable reports, but meta-analysis estimates that it affects 0.5 to 1.2 persons per 100,000 per year[3,4] Achalasia can affect both genders, all races and all ages. Achalasia is likely the best described primary esophageal motility disorder with clear clinical, manometric, endoscopic and radiologic findings[2,3]. Manometry is the gold standard for diagnosis of achalasia into 3 subtypes with different manometric patterns: Type I (classic achalasia of aperistalsis and failure of the LES to relax), Type II (with esophageal compression) and Type III (spastic achalasia) as defined by the Chicago classification[3,7]. Endoscopy will demonstrate food particles in the absence of a mucosal stricture and a narrowed gastroesophageal junction, the latter of which is well learned as the “bird’s beak” appearance on barium esophagram[3,7]

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