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In This Article

  • Summary
  • Abstract
  • Introduction
  • Protocol
  • Representative Results
  • Discussion
  • Acknowledgements
  • Materials
  • References
  • Reprints and Permissions

Summary

Surgical myotomy with a partial fundoplication may be used in selected patients as a definitive treatment for achalasia. This article provides a step-by-step description of a robotic myotomy and partial fundoplication in a 32-year-old patient with megaesophagus.

Abstract

Laparoscopic Heller myotomy is currently considered the standard definitive treatment of achalasia. With the advancements in technology, robotic Heller myotomy has emerged as an alternative approach to traditional laparoscopy due to three-dimensional (3D) visualization, fine motor control, and improved ergonomics provided by the robot.

Although there is a lack of randomized controlled trials, robotic-assisted Heller myotomy seems to be associated with lower rates of intraoperative perforations compared to the laparoscopic approach. A robotic approach may also improve surgical outcomes by providing a more complete myotomy.

Here, we describe the detailed steps of robotic myotomy and partial fundoplication for achalasia.

Introduction

Achalasia is a primary neurodegenerative esophageal motility disorder characterized by abnormal peristalsisand failure of the lower esophageal sphincter to relax1. Treatment of achalasia aims to reduce the resting pressure of the lower esophageal sphincter, thereby allowing esophageal emptying2. There are multiple options for treating achalasia, such as oral pharmacologic therapy, endoscopic pharmacologic therapy3, pneumatic dilatation4, peroral endoscopic myotomy (POEM)5, and surgical myotomy6.

Protocol

The recording of the surgical procedure and the use of its content for scientific and educational reasons were explained to the patient; he then signed a consent form, according to the Institution's human ethics committee. Written informed consent for the surgical and anesthetic procedures was also obtained.

NOTE: Patients with a confirmed diagnosis of achalasia by manometry and barium esophagram findings can be included in the protocol for robotic myotomy and partial fundoplication. A pre.......

Representative Results

Representative results are shown in Table 1. The operation time was 112 min with a measured blood loss of 20 mL. The postoperative course was uncomplicated. The post-operative care was carried out in a regular hospital room. There was no need for an intensive care unit since there were no complications. A liquid diet was started after day one of the surgery - the patient did not report dysphagia. The patient was discharged in good condition on postoperative day 2, on a liquid diet. Soft food was graduall.......

Discussion

This protocol describes robotic myotomy and partial fundoplication as a treatment for achalasia. The article highlights a Heller Pinotti fundoplication, which consists of a variation of the classic Dor fundoplication. This technique, presented in the article, demonstrates the performance of three rows of sutures, instead of the classic two sutures performed in the Dor fundoplication. The optimal type of fundoplication, including total, anterior, or posterior has been extensively studied in the literature, but there is st.......

Acknowledgements

None.

....

Materials

NameCompanyCatalog NumberComments
Da Vinci Surgical SystemIntuitive Surgical
Needle driverIntuitive Surgical
Bipolar forcepsIntuitive Surgical
Bipolar Fenestrated GrasperIntuitive Surgical
UltracisionJohnson &  Johnson

References

  1. Moonen, A., Boeckxstaens, G. Current diagnosis and management of achalasia. Journal of Clinical Gastroenterology. 48 (6), 484-490 (2014).
  2. Tuason, J., Inoue, H. Current status of achalasia management: a review on diagnosis and treat....

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