Robot-assisted Laparoscopic Esophagomyotomy Versus Laparoscopic Esophagomyotomy for Treatment of Esophageal Achalasia: Siriraj Experience
Keywords:
Esophageal achalasia, laparoscopic esophagomyotomy, robotic-assisted esophagomyotomy, complicationsAbstract
Background: Laparoscopic esophagomyotomy (LEM) has become the standard treatment for achalasia.Recently, robot-assisted laparoscopic esophagomyotomy (RA-LEM) is emerging as a safe alternative to conventional
LEM. We hypothesized that RA-LEM may reduce intraoperative complications compared with LEM.
Objective: To compare RA-LEM with LEM in terms of intraoperative complications for the treatment of
achalasia.
Patients and Methods: A total of 42 patients underwent surgical treatment of achalasia at Siriraj Hospital between
1 December 2001 and 30 November 2013. A retrospective review of demographic data, perioperative course,
complications, and hospital stay was performed. Patients were divided into 2 groups: group A (RA-LEM) consisted of
29 patients and group B (LEM) consisted of 13 patients. Operative time, estimated blood loss, duration of stay,
intraoperative and postoperative complication were analyzed.
Results: We could not demonstrate significant differences in esophageal perforation (13.8 vs. 15.4%; P = 0.999),
aspiration (6.9 vs. 0%; P = 0.999) and operative time (195 ± 42 vs 197 ± 45 minutes; P = 0.999) between RA-LEM and
LEM groups. There were significant reductions in blood loss (26.90 ± 45.13 vs 74.62 ± 45.21 ml; P < 0.001) and
postoperative length of stay (4.10 ± 1.18 vs 7.92 ± 6.43 days; P < 0.001).
Conclusions: There was no significant reduction in intraoperative and postoperative complication between RALEM
and LEM. We concluded that robotic surgery is equivalent in feasibility and safety to conventional LEM. RA-LEM
may be associated with less blood loss and shorter hospital stay.
References
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Heller’s myotomy versus pneumatic dilation in the treatment
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surgical treatments for achalasia: a systematic review and
meta-analysis. Ann Surg 2009;249:45-57.
10. Horgan S, Galvani C, Gorodner MV, et al. Robotic-assisted
esophagomyotomy versus laparoscopic esophagomyotomy
for the treatment of esophageal achalasia: multicenter
study. J Gastrointest Surg 2005;9:1020-9.
11. Melvin WS, Dundon JM, Talamini M, et al. Computerenhanced
robotic telesurgery minimizes esophageal
perforation during Esophagomyotomy. Surgery 2005;138:553-8.
12. Galvani C, Gorodner MV, Moser F, et al. Laparoscopic
Esophagomyotomy for achalasia facilitated by robotic
assistance. Surg Endosc 2006;20:1105-12.
13. Huffmanm LC, Pandalai PK, Boulton BJ, et al. Robotic
Esophagomyotomy: a safe operation with higher
postoperative quality-of-life indices. Surgery 2007;142:613-
8.
14. Shaligram A, Unnirevi J, Simorov A, et al. How does the robot
affect outcomes? A retrospective review of open,
laparoscopic, and robotic Esophagomyotomy for achalasia.
Surg Endosc 2012;26:1047-50.
15. Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic
esophagomyotomy and fundoplication for achalasia. Ann
Surg 1997;225:655-64.
16. Patti MG, Arcerito M, De Pinto M, et al. Comparison of
thoracoscopic and laparoscopic Esophagomyotomy for
achalasia. J Gastrointest Surg 1998;2:561-6.
17. Finley RJ, Clifton JC, Stewart KC, et al. Laparoscopic
Esophagomyotomy improves esophageal emptying and
the symptoms of achalasia. Arch Surg 2001;136:892-6.
18. Zaninotto G, Costantini M, Molena D, et al. Minimally invasive
surgery for esophageal achalasia. J Laparoendosc Adv
Surg Tech A 2001;11:351-9.
19. Bloomston M, Serafini F, Rosemurgy AS. Videoscopic
esophagomyotomy as first-line therapy for severe achalasia.
Am Surg 2001;67:1105-9.
20. Sharp KW, Khaitan L, Scholz S, et al. 100 consecutive minimally
invasive Heller myotomies: lessons learned. Ann Surg 2002;
235:631-8.
21. Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for
achalasia: late results of a prospective follow up investigation.
Gut 2004;53:629-33.
22. Gockel I, Sgourakis G, Drescher DG, et al. Impact of minimally
invasive surgery in the spectrum of current achalasia
treatment options. Scand J Surg 2011;100:72-7.
review of epidemiological studies. Am J Gastroenterol.
1998;93:2345-7.
2. Goldblum JR, Whyte RI, Orringer MB, et al. Achalasia. A
morphologic study of 42 resected specimens. Am J Surg
Pathol 1994;18:327-37.
3. Brewer LA, 3rd. History of surgery of the esophagus. Am J
Surg. 1980 ;139:730-43.
4. Heller E. Extramuköse Kardioplastik beim chronischen
Kardiospasmus mit Dilatation des Ösophagus. Mitt Grenzgeb
Med Chir 1914;27:141-9.
5. Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923;77:615-
7.
6. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyotomy.
Initial experience with a new approach
for the treatment of achalasia. Ann Surg 1992;216:291-6.
7. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic
cardiomyotomy for achalasia. J R Coll Surg Edinb 1991;36:152-
4.
8. Yaghoobi M, Mayrand S, Martel M, et al A. Laparoscopic
Heller’s myotomy versus pneumatic dilation in the treatment
of idiopathic achalasia: a meta-analysis of randomized,
controlled trials. Gastrointest Endosc 2013;78:468-75.
9. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and
surgical treatments for achalasia: a systematic review and
meta-analysis. Ann Surg 2009;249:45-57.
10. Horgan S, Galvani C, Gorodner MV, et al. Robotic-assisted
esophagomyotomy versus laparoscopic esophagomyotomy
for the treatment of esophageal achalasia: multicenter
study. J Gastrointest Surg 2005;9:1020-9.
11. Melvin WS, Dundon JM, Talamini M, et al. Computerenhanced
robotic telesurgery minimizes esophageal
perforation during Esophagomyotomy. Surgery 2005;138:553-8.
12. Galvani C, Gorodner MV, Moser F, et al. Laparoscopic
Esophagomyotomy for achalasia facilitated by robotic
assistance. Surg Endosc 2006;20:1105-12.
13. Huffmanm LC, Pandalai PK, Boulton BJ, et al. Robotic
Esophagomyotomy: a safe operation with higher
postoperative quality-of-life indices. Surgery 2007;142:613-
8.
14. Shaligram A, Unnirevi J, Simorov A, et al. How does the robot
affect outcomes? A retrospective review of open,
laparoscopic, and robotic Esophagomyotomy for achalasia.
Surg Endosc 2012;26:1047-50.
15. Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic
esophagomyotomy and fundoplication for achalasia. Ann
Surg 1997;225:655-64.
16. Patti MG, Arcerito M, De Pinto M, et al. Comparison of
thoracoscopic and laparoscopic Esophagomyotomy for
achalasia. J Gastrointest Surg 1998;2:561-6.
17. Finley RJ, Clifton JC, Stewart KC, et al. Laparoscopic
Esophagomyotomy improves esophageal emptying and
the symptoms of achalasia. Arch Surg 2001;136:892-6.
18. Zaninotto G, Costantini M, Molena D, et al. Minimally invasive
surgery for esophageal achalasia. J Laparoendosc Adv
Surg Tech A 2001;11:351-9.
19. Bloomston M, Serafini F, Rosemurgy AS. Videoscopic
esophagomyotomy as first-line therapy for severe achalasia.
Am Surg 2001;67:1105-9.
20. Sharp KW, Khaitan L, Scholz S, et al. 100 consecutive minimally
invasive Heller myotomies: lessons learned. Ann Surg 2002;
235:631-8.
21. Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for
achalasia: late results of a prospective follow up investigation.
Gut 2004;53:629-33.
22. Gockel I, Sgourakis G, Drescher DG, et al. Impact of minimally
invasive surgery in the spectrum of current achalasia
treatment options. Scand J Surg 2011;100:72-7.
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Published
2015-03-30
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Chinswangwatanakul V, Lerstsirithong A, Akaraviputh T, Trakarnsanga A, Methasate A, Boonnuch W. Robot-assisted Laparoscopic Esophagomyotomy Versus Laparoscopic Esophagomyotomy for Treatment of Esophageal Achalasia: Siriraj Experience. Thai J Surg [Internet]. 2015 Mar. 30 [cited 2024 Dec. 23];36(1). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226231
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