Clinical and pathophysiological outcomes of the robotic-assisted Heller–Dor myotomy for achalasia: a single-center experience

Pallabazzer, Giovanni; Peluso, Carla; Bortoli, Nicola de; Solito, Biagio; D’Imporzano, S; Belluomini, Mario Antonio; Bellomini, Maria Grazia; Giusti, Patrizia; Gianetri, Debora; Santi, Silvia De

doi:10.1007/s11701-019-00988-1

Cited by 10 publications

(11 citation statements)

References 20 publications

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“…The rate of esophageal mucosal perforation is of primary consideration throughout the literature. There are no noted mucosal perforations in any of the case reports and only 1 perforation noted in the retrospective reviews [14,15,21,22,24,25,27,32] . In a review of the progression of the role of myotomy, Allaix and Patti [33] highlight two separate studies that show rates of mucosal perforation in LHM being 16% and 8%, while the RHM groups had a 0% perforation rate in both studies.…”

Section: Review Of Literature: Robotic Heller Myotomymentioning

confidence: 84%

“…The use of Cadiere forceps and fenestrated bipolar forceps to perform myotomy with blunt dissection is used [26] . Previous studies have cited the utilization of endoscopic balloon inflation across the EGJ during this portion of the procedure for visualization of planes with some success [27] .…”

Section: Heller Myotomymentioning

confidence: 99%

“…If the patient passes the swallow study, tolerating liquid diet, voiding appropriately, and if pain is controlled, he/she can be discharged as early as postoperative day 1. The patient should be allowed slow progression from full liquid to soft food diet over the next 2-4 weeks [27] . Follow-up is scheduled for 1 month.…”

Section: Postoperative Managementmentioning

confidence: 99%

“…Each case report indicates short-term post-operative relief of dysphagia symptoms [22,24,25,32] . Two larger studies of greater than 50 patients reported a 92.4% and 100% rate of relief for dysphagia symptoms following operation with 80% of patients needing no further intervention [13,27] . In comparison to LHM, Kim et al [14] suggests that the technical advantage of the robotic approach allows for a longer myotomy incision, resulting in greater durability of symptomatic relief for dysphagia.…”

Section: Review Of Literature: Robotic Heller Myotomymentioning

confidence: 99%

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Robotic Heller myotomy

Sollie¹,

Jiwani²,

Wei³

2020

Mini-invasive Surg

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Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects motility, causing symptoms such as progressive dysphagia with liquids then solids, heartburn, regurgitation, odynophagia, weight loss, nocturnal cough, and chest pain. Evaluation will show a characteristic "bird's beak" appearance on barium esophagram and diagnosis is confirmed with esophageal manometry. Durable relief from the symptoms of achalasia can be achieved with pneumatic dilation, per-oral endoscopic myotomy, or surgical myotomy. Laparoscopic Heller myotomy with Dor (or Toupet) fundoplication for many years had been considered the gold standard for therapy. Since its development in 2001, the robotic Heller myotomy (RHM) has gained increasing popularity. Studies have shown equivalent efficacy of relieving achalasia symptoms but decreased incidence of esophageal perforation with RHM. The higher cost of RHM remains the largest barrier. Our objective was to provide a brief review of the current literature related to RHM and provide a detailed description of how to perform the procedure.

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Section: Review Of Literature: Robotic Heller Myotomymentioning

confidence: 84%

Section: Heller Myotomymentioning

confidence: 99%

Section: Postoperative Managementmentioning

confidence: 99%

Section: Review Of Literature: Robotic Heller Myotomymentioning

confidence: 99%

See 2 more Smart Citations

Robotic Heller myotomy

Sollie¹,

Jiwani²,

Wei³

2020

Mini-invasive Surg

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“…Although robot technology does increase the cost of hand operation in the treatment of these functional esophageal diseases, it can also bring good clinical, imaging and functional results. We operated on this disease by transthoracic robot, also because we were very familiar with Heller Dor operation under thoracoscopy [22].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

Sun

Wang

et al. 2020

Preprint

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Background Since our hospital installed the DaVinci ® Xi system, we have performed 60 thoracic surgeries in four months. As 25 of these 60 patients contain various types of esophageal benign and malignant diseases, we have no time to summarize our work after understanding and learning the experience of previous experts, so as to share our preliminary experience in using DaVinci ® Xi system in esophageal surgery. Because robot surgery system is the most effective for small and hard to reach areas, we have made many attempts in benign esophageal diseases. Compared with DaVinci ® Si, DaVinci ® Xi has many new functions, so we explore new surgical methods for some special esophageal cancer cases, such as the robot assisted modified Sweet operation.Methods Using DaVinci® Xi system(Intuitive Surgical, China), we performed robotic assisted thoracoscopic surgery (RATS) on 15 patients with esophageal cancer and 10 patients with various types of esophageal benign diseases. Among all esophageal cancer patients, 6 patients with lower esophageal cancer underwent resection of left thoracic esophageal cancer and lymphadenectomy, then diaphragm was cut, stomach was separated from abdominal cavity and lymphadenectomy was performed. Finally, 5 cases were anastomosed with stomach and esophagus under the aortic arch, and 1 case was anastomosed with stomach and esophagus in the neck combined with mediastinoscopic neck lymphadenectomy. McKeown was performed in 3 of the other 9 cases. Six patients underwent the Ivor Lewis operation, one of them was converted to the left thoracogastrostomy because of the extensive adhesion of the right thoracic cavity. Other benign diseases included esophageal leiomyomectomy in 3 cases, esophageal diverticulum in 1 case, hiatal hernia in 4 cases, esophageal cyst in 1 case, achalasia in 1 case. Results All the procedures were successfully completed by robot except one patient with extensive adhesion of right thoracic cavity and only abdominal operation. The median operation time of esophageal cancer patients was 286（240-348 minutes,There were no complications during operation. One patient had a neck anastomotic leakage and the wound healed after local washing for 3 weeks. Because of the short time of observation, there is no death of malignant tumor and no serious complication of benign disease. Conclusions Through the experience of such a small series of robotic assisted thoracoscopic surgery for various esophageal diseases, we support the impression that: 1. The esophagus is an ideal organ for robotic surgery, which is a good indication for malignant tumor surgery; 2. Under the vision of the robot, each layer of esophageal mucosa can be seen clearly, which is very conducive to the resection of small leiomyoma or cyst In addition, 3. Flexible arms can be used for various anastomosis or suture operations. 4. Through the left thorax and diaphragm incision can be used as a "robot" Sweet operation for the right patient, with mediastinoscopy to clean up the upper mediastinal lymph nodes can achieve better results.

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Robotic Heller‐Dor procedure for oesophageal achalasia: Fluorescence‐guided intraoperative assessment of myotomy. A retrospective single‐centre experience

Romanzi

D’Alba

Campagna

et al. 2022

Robotics Computer Surgery

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Background The robotic Heller‐Dor (RHD) procedure for oesophageal achalasia (EA) is safe and effective. We aim to evaluate the intraoperative use of fluorescence imaging, as an alternative means to intraoperative endoscopy, to assess myotomy at the end of the procedure. Methods Thirty‐four patients affected with EA underwent RHD. The myotomy was assessed intraoperatively by endoscopy in group A (17 patients), and by fluorescence imaging in group B (17 patients). Perioperative and long‐term results were compared. Results In group A, one mucosal tear was identified during intraoperative endoscopy. In group B, indocyanine green (ICG) helped identify residual muscle fibres in three cases. No perforation of the oesophageal mucosa occurred in group B. Conclusions Fluorescence‐imaging improved the identification of residual muscle fibres and made it possible to verify the integrity of the mucosa without the use of intraoperative endoscopy. A significant reduction in operative times has been related to the use of this technique.

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Clinical and pathophysiological outcomes of the robotic-assisted Heller–Dor myotomy for achalasia: a single-center experience

Cited by 10 publications

References 20 publications

Robotic Heller myotomy

Robotic Heller myotomy

Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

Robotic Heller‐Dor procedure for oesophageal achalasia: Fluorescence‐guided intraoperative assessment of myotomy. A retrospective single‐centre experience

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