Laparoscopic versus Robotic-Assisted Heller Myotomy for the Treatment of Achalasia: An ACS-NSQIP Analysis

BackgroundThe adoption of robotic surgery has increased in foregut procedures, but its comparative value to laparoscopy in Heller myotomy remains unclear. We sought to evaluate the short-term perioperative outcomes of the robotic vs laparoscopic approach for Heller myotomy.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2022 to 2023 was queried for patients undergoing Heller myotomy, in which the "robotic" variable was included. Outcomes were evaluated using univariable analysis and multivariable logistic and linear regression.ResultsA total of 712 patients underwent a Heller myotomy; laparoscopy accounted for 63.6% of cases (n = 453) and robotic 36.3% (n = 259). The cohorts were matched aside from higher rates of HTN in the robotic group (42.9% vs 34.7%, P < 0.05). Robotic Heller myotomy had significantly (P < 0.05) greater use of intraoperative EGD (22.8% vs 16.8%) and balloon distension studies (5.4% vs 1.5%). The robotic approach was associated with a longer median operative time (167 min vs 119.5 min) and independently associated with longer operative time on linear regression (β 35.39 min, CI 26.19-45.96 min). There were no significant differences in short-term complications including reoperation, readmission, and mortality.DiscussionThese data suggest no significant differences in the short-term outcomes between robotic and laparoscopic Heller myotomy. Robotic surgery was associated with longer operative times and utilization of more EGD and balloon distension studies. Further research is required to evaluate the clinical benefit of robotic surgery in achalasia.