PURPOSE: The surgical treatment of achalasia remains controversial. Controversy includes thoracic versus an abdominal approach and the need for an antireflux procedure. Due to the technical difficulties associated with a thoracoscopic myotomy, the vast majority of minimally invasive myotomies are performed by laparoscopy. Laparoscopic Heller myotomy is hampered by the requiremnt of an added antireflux procedure and its potential complications. The daVinci surgical robot which enables 3-D visualization, complex maneuvers, and accurate dissection, may facilitate thoracoscopic myotomy.
METHODS: From 12/05 to 1/07 10 patients underwent robot-assisted thoracoscopic esophageal myotomy for achalasia without an antireflux procedure. Diagnosis of achalasia was confirmed by radiography, endoscopy and manometry. Patients underwent intraopertive EGD. Robot-assisted myotomy was accomplished through 4 ports in the left chest. Myotomy was extended approximately 1cm onto the proximal stomach. Success of the myotomy was determined by introperative EGD, postoperative contrast radiography and subjective improvement of dyspahgia and symptoms of reflux.
RESULTS: There were 3 men and 7 women. 7/10 patients had undergone botulinum toxin injection. There were no mucosal injuries or conversion to a thoracotomy. Median hospitalization was 4 days. All patients reported improvement in dysphagia. 6/10 patients reported symptoms of reflux which was controlled by nonprescription antacids.
CONCLUSION: Robot-assistance facilitates thoracoscopic Heller myotomy.
CLINICAL IMPLICATIONS: Although greater experience is required, the preliminary results of this study suggest that robot-assisted thoracoscopic Heller Myotomy without an antireflux procedure may represent an excellent alternative to laparoscopic myotomy with an antireflux procedure.
DISCLOSURE: Farid Gharagozloo, No Financial Disclosure Information; No Product/Research Disclosure Information