Abstract
Achalasia is a motility disease of the esophagus, characterized by the absence of peristalsis in the esophageal body and incomplete relaxation of the lower esophageal sphincter, which may be hypertensive. Therefore, the aim of the therapy is to improve esophageal emptying by eliminating the outflow resistance caused by the lower esophageal sphincter. Since the advent of laparoscopy, endoscopic treatment modalities have been replaced by laparoscopic Heller myotomy as the procedure of choice to treat achalasia. This radical change replicated the excellent results of open surgery with relief of dysphagia in 85–95 % of the patients but with shorter hospital stay, faster recovery and minimal postoperative discomfort. However, laparoscopic myotomy poses technical challenges for the surgeons and requires an extensive learning curve, which contributes with the significant number of intraoperative mucosal perforations. Robotic-assisted Heller myotomy sheds new light on minimally invasive treatments by dealing with these technical challenges and improving outcomes.
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References
Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol. 1994;18(4):327–37.
Beck WC, Sharp KW. Achalasia. Surg Clin North Am. 2011;91(5):1031–7.
Eckardt AJ, Eckardt VF. Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol. 2011;8(6):311–9.
Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology. 2010;139:369–74.
Mostafa RM, Moustafa YM, Hamdy H. Interstitial cells of Cajal, the Maestro in health and disease. World J Gastroenterol. 2010;16(26):3239–48.
Sadowski DC, Ackah F, Jiang B, Svensons LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9):e256–61.
Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci. 2009;54:1680–5.
Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230(4):587–93. discussion 593–4.
Perreta S, Fisichella PM, Galvani G, Gorodner MV, Way LW, Patti MG. Achalasia and chest pain: effect of laparoscopic Heller myotomy. J Gastrointest Surg. 2003;7(5):595–8.
Moonka R, Patti MG, Feo CV, Arcerito M, De Pinto M, Horgan S, et al. Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg. 1999;3(5):456–61.
Sandler RS, Nyren O, Ekbom A, Eisen GM, Yuen J, Josefsson S. The risk of esophageal cancer in patients with achalasia. A popular-based study. JAMA. 1995;274(17):1359–62.
Gorodner MV, Galvani C, Patti MG. Heller myotomy. J Op Tech Gen Surg. 2004;6(1):23–38.
Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, International High Resolution Manometry Working Group. Chicago classification criteria of esophageal motility disorders defined in high-resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24 Suppl 1:57–65.
Patti MG, Fisichella PM, Perreta S, Galvani C, Gorodner MV, Robinson T, et al. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg. 2003;196(5):698–703.
Bresadola V, Feo CV. Minimally invasive myotomy for the treatment of esophageal achalasia: evolution of the surgical procedure and the therapeutic algorithm. Surg Laparosc Endosc Percutan Tech. 2012;22(2):83–7.
Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, et al. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010;252(2):254–62.
Horgan S, Galvani C, Gorodner MV, Omelanczuk P, Elli F, Moser F, et al. Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg. 2005;9(8):1020–30.
Melvin WS, Dundon JM, Talamini M, Horgan S. Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy. Surgery. 2005;138(4):553–9.
Galvani CA, Gallo AS, Dylewski MR. Robotic-assisted Heller myotomy for esophageal achalasia: feasibility, technique, and short-term outcomes. J Robot Surg. 2011;5:163–6.
Bloomston M, Serafini F, Boyce HW, Rosemurgy AS. The “learning curve” in videoscopic Heller myotomy. JSLS. 2002;6(1):41–7.
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Samamé, J., Dylewski, M.R., Echeverria, A., Galvani, C.A. (2014). Achalasia. In: Kim, K. (eds) Robotics in General Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8739-5_6
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DOI: https://doi.org/10.1007/978-1-4614-8739-5_6
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