Robot-assisted Laparoscopic Esophagomyotomy Versus Laparoscopic Esophagomyotomy for Treatment of Esophageal Achalasia: Siriraj Experience
Keywords:Esophageal achalasia, laparoscopic esophagomyotomy, robotic-assisted esophagomyotomy, complications
AbstractBackground: 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
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.
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