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Updated: Jul 27, 2025
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Use real-time near-infrared fluorescence during Heller's cardiomyotomy for achalasia cardia
Srikanth Gadiyaram1, Ravikiran Thota1, Murugappan Nachiappan1
1Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospital, Bengaluru, Karnataka, India.
Insights
This study introduces a new method using Indocyanine Green (ICG) fluorescence to ensure surgical success after laparoscopic Heller
Area of Science:
- Surgical innovation
- Gastroenterology
- Minimally invasive surgery
Background:
- Laparoscopic Heller's cardiomyotomy is the standard treatment for esophageal achalasia.
- Confirming myotomy completeness and mucosal integrity is crucial post-surgery.
- Current methods include endoscopy and air leak tests, with limitations.
Purpose of the Study:
- To present a novel method using real-time near-infrared Indocyanine Green (ICG) fluorescence.
- To evaluate ICG fluorescence for confirming myotomy completeness and mucosal integrity.
- To establish ICG as a viable tool in laparoscopic Heller's cardiomyotomy.
Main Methods:
- Intraoperative near-infrared fluorescence imaging with Indocyanine Green (ICG).
- Laparoscopic Heller's myotomy procedure.
- Real-time visualization of myotomy site and mucosal integrity.
Main Results:
- Successfully visualized myotomy completeness using ICG fluorescence.
- Confirmed mucosal integrity at the myotomy site.
- Demonstrated the feasibility of real-time ICG integration.
Conclusions:
- Real-time near-infrared ICG fluorescence is a promising tool for laparoscopic Heller's myotomy.
- This method offers a reliable way to confirm surgical success.
- ICG fluorescence represents a significant advancement in managing esophageal achalasia.
Abstract:
Laparoscopic Heller's cardiomyotomy is the surgical procedure of choice in the management of oesophageal achalasia. It is critical to confirm the completeness of the myotomy and mucosal integrity at the conclusion of the procedure. This is conventionally achieved by intraoperative endoscopy and dynamic air leak test. Other modalities that can be used to confirm the myotomy and the integrity of the mucosa at the myotomy site are oesophageal manometry and a methylene blue dye study, respectively. Indocyanine green (ICG) has been in clinical use for more than six decades. The real-time integration of ICG fluorescence with laparoscopy is a relatively new breakthrough. Here, we present a novel method of using real-time near-infrared ICG fluorescence for confirming the completeness of the myotomy and mucosal integrity at the myotomy site post laparoscopic Heller's myotomy. This is the first report on the use of ICG in laparoscopic Heller's cardiomyotomy that we are aware of.
