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Sollie et al. Mini-invasive Surg 2020;4:80 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.81

Technical Note Open Access

Robotic Heller myotomy

Zachary W. Sollie , Alisha Z. Jiwani , Benjamin Wei 2
1
2
1 University of Alabama School of Medicine, Birmingham, AL 35233, USA.
2 Division of Cardiothoracic Surgery, University of Alabama Birmingham, Birmingham, AL 35294, USA.

Correspondence to: Dr. Benjamin Wei, Division of Cardiothoracic Surgery, University of Alabama Birmingham, Zeigler Research
Building 707, 703 19th Street South, Birmingham, AL 35294, USA. E-mail: bwei@uab.edu

How to cite this article: Sollie ZW, Jiwani AZ, Wei B. Robotic Heller myotomy. Mini-invasive Surg 2020;4:80.
http://dx.doi.org/10.20517/2574-1225.2020.81

Received: 7 Aug 2020 First Decision: 14 Sep 2020 Revised: 23 Sep 2020 Accepted: 24 Sep 2020 Published: 6 Nov 2020
Academic Editor: Noriyoshi Sawabata Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects motility, causing
symptoms such as progressive dysphagia with liquids then solids, heartburn, regurgitation, odynophagia,
weight loss, nocturnal cough, and chest pain. Evaluation will show a characteristic “bird’s beak” appearance on
barium esophagram and diagnosis is confirmed with esophageal manometry. Durable relief from the symptoms
of achalasia can be achieved with pneumatic dilation, per-oral endoscopic myotomy, or surgical myotomy.
Laparoscopic Heller myotomy with Dor (or Toupet) fundoplication for many years had been considered the gold
standard for therapy. Since its development in 2001, the robotic Heller myotomy (RHM) has gained increasing
popularity. Studies have shown equivalent efficacy of relieving achalasia symptoms but decreased incidence
of esophageal perforation with RHM. The higher cost of RHM remains the largest barrier. Our objective was to
provide a brief review of the current literature related to RHM and provide a detailed description of how to perform
the procedure.

Keywords: Heller myotomy, achalasia, robotic, surgical treatments for achalasia, minimally invasive surgery

INTRODUCTION
Achalasia is a neurodegenerative disorder of the esophagus characterized by failure of the lower esophageal
sphincter (LES) to relax and decrease or absence of esophageal body peristalsis [1-3] . The incidence has
[3,4]
variable reports, but meta-analysis estimates that it affects 0.5 to 1.2 persons per 100,000 per year
Achalasia can affect both genders, all races and all ages. A few studies have suggested that disease risk increases

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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