The following is the summary of “A comparative study of robotic and laparoscopic approaches to Heller myotomy” published in the December 2022 issue of Thoracic and cardiovascular surgery by Raja, et al.
Recently, robotic assistance has been used in the laparoscopic method of performing a Heller myotomy for achalasia. The results of the 2 methods are compared. Heller myotomy with anterior fundoplication was performed on 447 patients between January 2010 and January 2020 (170 with robotic assistance and 277 laparoscopically). Timed barium esophagram was used to measure esophageal emptying in the short and long term, symptom alleviation was measured using the Eckardt score, and reintervention was time-related. In a study including 328 people, non-sigmoidal esophageal morphology with a breadth of fewer than 5 centimeters was considered normal. In addition, they conducted a propensity score-matched analysis to compare the efficacy of robotic and laparoscopic procedures.
Complete emptying at 5 minutes was seen on a timed barium esophagram in 58% (77/132) of the robotic group and 48% (115/241) of the laparoscopic group (within 6 months of surgery). Patients with normal esophageal morphology who were matched for propensity scores also had a higher longitudinal prevalence of complete barium emptying at 5 minutes in the robotic .group (54% vs. 34% at 4 years; P=.05), higher intermediate-term Eckardt scores (1.7% vs 10% > 3 at 4 years; P=.0008), and fewer interventions (1.2% vs 11% at 3 years; P=.04).
Patients with achalasia who underwent either robotic-assisted or laparoscopic Heller myotomy experienced successful outcomes. Evidence suggests that the robotic approach may be associated with improved esophageal emptying, symptom palliation, and freedom from reintervention in the intermediate term in a matched subgroup of patients with normal esophageal morphology within this heterogeneous disease. Long-term research is needed to see if this trend holds.