Robotic Heller Myotomy

Achalasia is an esophageal motor disorder characterized by the failure of the lower esophageal sphincter (LES) to relax and the loss of peristalsis in the esophageal body. Treatment options aim to alleviate the elevated pressure of the LES and include direct botulinum toxin injection, pneumatic dilation, per-oral endoscopic myotomy (POEM), and Heller myotomy. Traditionally, laparoscopic Heller myotomy with partial fundoplication has been the gold standard for treating achalasia. However, the robotic approach is gaining popularity for foregut operations. The robotic system facilitates an extended esophageal mediastinal dissection further up into the chest. It also offers excellent visualization of the esophageal layers, resulting in a smoother and safer myotomy. The addition of a partial fundoplication, whether anterior or posterior, to Heller myotomy significantly reduces the risk of esophageal reflux. This risk decreases from approximately 50% without a fundoplication to less than 10% with a partial fundoplication. The robotic technique, with its enhanced precision and visualization, represents a promising advancement in the management of achalasia.