Farid Gharagozloo, Marc Margolis, Barbara Tempesta.
George Washington University Medical Center, Washington, DC, USA.
Background:
The surgical treatment of Achalasia remains controversial. Controversies include thoracic versus an abdominal approach and the need for an antireflux procedure. Historically, transthoracic myotomy has been accomplished without an antireflux procedure. Howeve, due to instrument limitations, transthoracic myotomy has been difficult to accomplish by thoracoscopy. Consequently laparoscopic myotomy has become more popular. On the other hand, laparoscopic heller myotomy is associated with the need for an added antireflux procedure. The daVinci surgical robot which enables 3D visualization, greater dexterity and more accurate dissection may facilitate thoracoscopic heller myotomy.
METHODS:
From 1/06 to 12/07, 16 patients underwent robotic thoracoscopic distal esophageal myotomy for Achalasia without an antireflux procedure. Diagnosis of Achalasia was confirmed by preoperative radiography, endoscopy and manometry. Patients underwent intraopertaive EGD. Robotic myotomy was accomplished through 4 ports in the left chest. Success of myotomy was determined by intraoperative EGD, postoperative contrast radiography and subjective improvement of dysphagia and onset of new reflux.
RESULTS:
There were 5 men and 11women. All patients had undergone multiple dilations, and 7 (44%) had undergone preoperative botulinum toxin injection. There were no mucosal injuries. There were no conversions to thoracotomy. Median hospitalization was 3 days. All patients had improvement in dysphagia. There was no new subjective reflux.
CONCLUSIONS:
Although greater experience is necessary, Robotic thoracoscopic Heller myotomy is feasible. Based on our early experience this approach without an antireflux procedure results in excellent relief of dysphagia without new symptomatic reflux.
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