Skip to main content
SpringerLink
Log in

Robotic Heller-Dor for Idiopathic Achalasia: the Pisa experience

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Achalasia is a rare motility disorder of the esophagus. According to the Chicago Classification criteria, there are three clinical types of Achalasia and the treatment is patient-tailored. Laparoscopic Heller-Dor is the gold-standard treatment for the most frequent types of Achalasia. However, robotic surgery is able to combine the clinical advantages of minimally invasive surgery with a powerful dexterity on complex anatomic structures. The aim of this study is to report the institutional experience developed in a referral center of esophageal surgery in the treatment of Achalasia by Robotic Heller-Dor. We retrospectively analyzed data of patients that consecutively underwent Robotic Heller-Dor at our institution between January 2012 and January 2020 using the Da Vinci® Surgical System. Sixty-nine patients underwent Robotic Heller-Dor. Among the patients, 35 (51%) were classified as type I, 29 (42%) as type II, and 5 (7%) as type III. The Da Vinci® SI HD Surgical System and the Da Vinci® XI HD Surgical System were used in 56 (81%) and 13 (19%) patients, respectively. No mucosal perforation was observed and post-operative mortality was absent. The mean follow-up was 23.3 months (6–84). Ten patients (14.5%) reported post-operative complaints. In our opinion, Robotic Heller-Dor is an effective tool in the treatment of Achalasia. Robotic Heller-Dor may be a suitable procedure for learning and teaching robotic surgery in the perspective of pursing more complex esophago-gastric surgical procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All data are available at the corresponding Author.

Code availability

Not applicable.

Abbreviations

IA:

Idiopathic Achalasia

HRM:

High-Resolution Manometry

EGJ:

Esophago-gastric junction

LHD:

Laparoscopic Heller-Dor

HD:

Heller-Dor procedure

PD:

Endoscopic pneumatic dilation

RHD:

Robotic Heller-Dor

POD:

Post-operative day

OT:

Operative time

MII-pH:

Multichannel intraluminal impedance and pH monitoring

POEM:

Per-Oral Endoscopic Myotomy

References

  1. Boeckxstaens GE, Zaninotto G, Richter JE (2014) Achalasia. Lancet 383:83–93. https://doi.org/10.1016/S0140-6736(13)60651-0 (Epub 2013 Jul 17)

    Article  PubMed  Google Scholar 

  2. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, Pandolfino JE & International High Resolution Manometry Working Group (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174. https://doi.org/10.1111/nmo.12477

    Article  Google Scholar 

  3. Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, Patti MG, Ribeiro U, Richter JJ, Swanstrom L, Tack J, Triadafilopoulos G, Markar SR, Salvador R, Faccio L, Andreollo NA, Cecconello I, Costamagna G, da Rocha JRM, Hungness ES, Fisichella PM, Fuchs KH, Gockel I, Gurski R, Gyawali CP, Herbella FAM, Holloway RH, Hongo M, Jobe BA, Kahrilas PJ, Katzka DA, Dua KS, Liu D, Moonen A, Nasi A, Pasricha PJ, Penagini R, Perretta S, Sallum RAA, Sarnelli G, Savarino E, Schlottmann F, Sifrim D, Soper N, Tatum RP, Vaezi MF, van Herwaarden-Lindeboom M, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Gittens S, Pontillo C, Vermigli S, Inama D, Low DE (2018) The 2018 ISDE achalasia guidelines. Dis Esophagus 31:1–29. https://doi.org/10.1093/dote/doy071

    Article  Google Scholar 

  4. Melvin WS, Needleman BJ, Krause KR, Wolf RK, Michler RE, Ellison EC (2001) Computer-assisted robotic Heller myotomy: initial case report. J Laparoendosc Adv Surg Tech A 11(4):251–253

    Article  CAS  Google Scholar 

  5. Pallabazzer G, Peluso C, De Bortoli N, Marano L, Solito B, D’Imporzano S, Belluomini MA, Bellomini MG, Giusti P, Gianetri D (2020) Clinical and pathophysiological outcomes of the robotic assisted heller-dor myotomy for achalasia a single center experience. J Robot Surg 14(2):331–335. https://doi.org/10.1007/s11701-019-00988-1 (Epub 2019 Jun 22)

    Article  PubMed  CAS  Google Scholar 

  6. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM and Pandolfino JE; on behalf of the International Working Group for Disorders of Gastrointestinal Motility and Function (2017) Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes. Nat Rev Gastroenterol Hepatol 14(11):677–688. https://doi.org/10.1038/nrgastro.2017.132 (Epub 2017 Sep 27)

    Article  Google Scholar 

  7. Litle VR (2008) Laparoscopic Heller myotomy for achalasia: a review of the controversies. Ann Thorac Surg 85(2):S743–S746. https://doi.org/10.1016/j.athoracsur.2007.12.004.)

    Article  PubMed  Google Scholar 

  8. Costantini M, Salvador R, Capovilla G, Vallese L, Costantini A, Nicoletti L, Briscolini D, Valmasoni M, Merigliano S (2019) A thousand and one laparoscopic heller myotomies for esophageal achalasia: a 25-Year experience at a single tertiary center. J Gastrointest Surg 23(1):23–35. https://doi.org/10.1007/s11605-018-3956-x (Epub 2018 Sep 20)

    Article  PubMed  Google Scholar 

  9. Zaninotto G, Costantini M, Molena D, Buin F, Carta A, Nicoletti L, Ancona E (2000) Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 4(3):282–289

    Article  CAS  Google Scholar 

  10. Parise P, Santi S, Solito B, Pallabazzer G, Rossi M (2011) Laparoscopic Heller myotomy plus Dor fundoplication in 137 achalasic patients: results on symptoms relief and successful outcome predictors. Updates Surg 63:11–15. https://doi.org/10.1007/s13304-011-0050-2

    Article  PubMed  Google Scholar 

  11. Milone M, Manigrasso M, Vertaldi S, Velotti N, Aprea G, Maione F, Gennarelli N, De Simone G, De Conno B, Pesce M, Sarnelli G, De Palma GD (2019) Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis. Dis Esophagus 32(10):1–8. https://doi.org/10.1093/dote/doz062

    Article  PubMed  CAS  Google Scholar 

  12. Shaligram A, Unnirevi J, Simorov A, Kothari VM, Oleynikov D (2012) How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia. Surg Endosc 26:1047–1050. https://doi.org/10.1007/s00464-011-1994-5

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Division of Esophageal Surgery Regional Referral Center “Mauro Rossi” for Diagnosis and Treatment of Diseases of Esophagus, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy

    Stefano Santi, Mario Antonio Belluomini, Simone D’Imporzano, Maria Grazia Bellomini, Biagio Solito, Debora Gianetri & Giovanni Pallabazzer

  2. Division of Radiology, Department of Radiology, Vascular and Interventional Radiology and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy

    Patrizia Giusti

Authors
  1. Stefano Santi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario Antonio Belluomini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simone D’Imporzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Grazia Bellomini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Biagio Solito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Debora Gianetri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Patrizia Giusti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giovanni Pallabazzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MAB, SD, GP, SS and DG. The first draft of the manuscript was written by SS and MAB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mario Antonio Belluomini.

Ethics declarations

Conflicts of interest

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santi, S., Belluomini, M.A., D’Imporzano, S. et al. Robotic Heller-Dor for Idiopathic Achalasia: the Pisa experience. Updates Surg 73, 2247–2252 (2021). https://doi.org/10.1007/s13304-021-01092-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-021-01092-6

Keywords

Search

Navigation