Robotic Heller Myotomy

Abstract

Achalasia is a relatively uncommon primary motility disorder of the esophagus characterized by incomplete or absent relaxation of the Lower Esophageal Sphincter (LES). Early definitive treatment is essential to prevent potential complications of the disease as well as improve patients’ quality of life. Treatment is always palliative and is aimed to decrease the outflow obstruction at the level of the LES. Heller esophageal myotomy has been considered the gold standard in the surgical management of achalasia. A minimally invasive approach offers better results in terms of minimal post operative pain, shorter hospital stay, shorter disability, lower cost, and a better cosmetic result compared to the open approach. Some of the pitfalls associated with laparoscopic Heller myotomy such as the effect of previous failed endoscopic treatments and the risk for esophageal perforation have been overcome with the emergence of robotic surgery. Several factors of robotic surgery including tremor elimination, freedom of movements, steadiness and 3-D visualization that provides a careful and more precise dissection of muscle fibers has helped ensure better safety and superior results. We have applied this technology for the treatment of esophageal achalasia with encouraging patient outcomes and no esophageal perforation. This chapter illustrates our current technique for Robotic Assisted Heller Myotomy and some of the common pearls and pitfalls.