Robotic-assisted Heller myotomy: a modern technique and review of outcomes

Achalasia is a debilitating esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter and lack of peristalsis. Manometry is the gold standard for diagnosis and laparoscopic Heller myotomy has been the gold standard for definitive therapy. However, current advances in surgical technology have introduced the robotic platform as a viable approach for this procedure. The safety and efficacy has been clearly established with comparable operative times to laparoscopy in experienced hands. Importantly, the rate of resolution of dysphagia postoperatively is over 80% which is comparable to laparoscopic outcomes. Moreover, some literature suggests lower esophageal perforation rates utilizing the robotic platform. Nevertheless, costs remain one of the largest barriers to widespread use of the robotic platform and future studies should aim to identify strategies in cost reduction.