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Updated: Jul 3, 2026
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Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia
Published on: February 16, 2024
Laparoscopic Heller myotomy using hook electrocautery: a safe, simple, and inexpensive alternative
Joshua E Roller1, Sebastián G de la Fuente, Eric J DeMaria
1Bariatric and Minimally Invasive Surgery, Northwest Medical Center, Springdale, AR 72764, USA. jroller@rollerweightloss.com
Surgical Endoscopy
|July 16, 2008
Summary
Laparoscopic Heller myotomy with Dor fundoplication using hook electrocautery is a safe and effective treatment for achalasia. This technique achieves low rates of esophageal perforation, comparable to robotic approaches but at lower cost.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Laparoscopic Heller myotomy (LHM) is the standard surgical treatment for achalasia.
- Historically, LHM has a 5-10% intraoperative esophageal perforation rate.
- Robotically assisted Heller myotomy is suggested to have a lower perforation rate.
Purpose of the Study:
- To evaluate the safety and efficacy of LHM with Dor fundoplication (LHMDF) using simple hook electrocautery.
- To assess the intraoperative esophageal perforation rate in a large series of LHMDF procedures.
Main Methods:
- Retrospective review of 54 patients undergoing LHMDF for achalasia by a single surgeon (2003-2006).
- Data collected included demographics, perioperative details, and follow-up information.
- Analysis focused on operative outcomes, complications, and patient follow-up.
Main Results:
- A low intraoperative esophageal perforation rate of 1.9% (1 patient) was observed.
- Only one patient (1.9%) required conversion to open surgery.
- Average hospital stay was 34 hours, with 3.7% experiencing persistent dysphagia at 5-month follow-up.
Conclusions:
- LHMDF using simple hook electrocautery is a safe, cost-effective, and effective treatment for achalasia.
- Meticulous surgical technique minimizes the risk of intraoperative esophageal perforation.
- Hook electrocautery offers safety comparable to robotic systems without increased cost or operative time.
