Robotic Heller’s cardiomyotomy for achalasia: early outcomes for a high-volume UK centre

Abstract

Introduction Heller’s cardiomyotomy (HCM) is the gold standard treatment for achalasia. Laparoscopic HCM has been shown to be effective with low rates of symptom recurrence, though oesophageal mucosal perforation rates remain high. The aim of this prospective case series is to assess the short-term complication rates and perioperative outcomes for the first cohort of patients undergoing robotic-assisted HCM for achalasia in a single high-volume UK centre. Methods Data were collected from a prospective cohort of patients who underwent robotic HCM at a single high-volume UK centre. Outcomes were assessed using the Eckhard score, which was calculated after their routine postoperative clinic appointments. Results Thirteen patients underwent robotic HCM during the study period; this is the second largest reported case series in the European literature. There were no intraoperative oesophageal perforations. Six patients were discharged as day cases, six patients were discharged on the first postoperative day and one patient’s hospital stay was two nights. There was a single perioperative complication of urinary retention. All patients reported improvement of symptoms following their operation, and all had a postoperative Eckhard score of less than 3, indicating their achalasia was in remission. Conclusions This cohort has demonstrated that robotic HCM has an exceptional safety profile and results in high levels of symptom resolution, even early in the learning curve. The robotic approach may be superior to laparoscopy as it allows more precise identification and dissection of the oesophageal muscle fibres, which likely reduces the risk of inadvertent mucosal damage or incomplete myotomy.

The impact of robotic surgery on the treatment of benign esophageal and gastric disease. Early experience of a specialized unit

“…[14] Early cases series on robotic Heller myotomies report excellent post-operative symptom relief, noninferior to that of the established laparoscopic approach with acceptable intraoperative and postoperative complication rate. [15][16][17][18][19][20][21][22][23] In fact, Kim et al presented superior average length of myotomy and improved symptom control with the robotic approach, while Raja et al demonstrated superior long-term symptom relief and decreased reintervention rate when comparing robotic to laparoscopic myotomy. [16,23] A number of studies report reduced incidence of intraoperative complication rate, mainly mucosal tears while using the robotic platform [15,18,20,22].…”