J Am Coll Surg. 2026 Jan 30. doi: 10.1097/XCS.0000000000001814. Online ahead of print.
ABSTRACT
BACKGROUND: Robotic surgery benefits include a binocular vision, increased dexterity, and adjustable hand control speed. We hypothesized perforation rate of robotic Heller myotomy (RH) was lower than laparoscopic Heller myotomy (LH).
STUDY DESIGN: A retrospective cohort study of a prospectively maintained database of 135 patients diagnosed with achalasia or esophagogastric junction outlet obstruction who underwent Heller myotomy by a single surgeon were identified for inclusion. After exclusions 107 patients were analyzed. Primary outcome was intraoperative perforation rate. Secondary outcomes were length of stay, short and long-term GERD Health Related Quality of Life (GERD-HRQL), dysphagia and Eckardt scores. Results are expressed mean + SD and statistical analysis performed with GraphPad Prism (10.4.2).
RESULTS: RH had a lower rate of intraoperative perforation (n=0), compared to LH (n=3, 13.6%) (p<0.01). The median length of stay was shorter for the RH group 1 day verses 2 days for LH (p<0.01). RH and LH significantly improved both GERD-HRQL and Eckardt scores in short term and long-term follow-up. Long term success (Eckardt score <3) was achieved in 88% of LH and in RH (p=0.03).
CONCLUSIONS: Robotic surgery allows for a safer myotomy with a significant reduction in intraoperative perforation rate and in LOS. Robotic surgery enhanced the surgeon’s performance of an extended myotomy resulting in long term success of RH. RH has decreased complication rates and is superior to LH and is our technique of choice.
PMID:41615705 | DOI:10.1097/XCS.0000000000001814
