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Gharagozloo et al. Mini-invasive Surg 2020;4:22 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.61

Original Article Open Access

Robotic lateral heller myotomy without

fundoplication for achalasia

Farid Gharagozloo, Nabiha Atituzzman, Basher Atiquzzman

Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health Celebration University of Central Florida,
Celebration, FL 34786, USA.

Correspondence to: Dr. Farid Gharagozloo, Center for Advanced Thoracic Surgery, Global Robotics Institute, Advent Health
Celebration University of Central Florida, 400 Celebration Place, Celebration, FL 34786, USA. E-mail: gharagozloof@aol.com

How to cite this article: Gharagozloo F, Atituzzman N, Atiquzzman B. Robotic lateral heller myotomy without fundoplication for
achalasia. Mini-invasive Surg 2020;4:22. http://dx.doi.org/10.20517/2574-1225.2019.61

Received: 17 Dec 2019 First Decision: 6 Feb 2020 Revised: 6 Mar 2020 Accepted: 13 Mar 2020 Published: 10 Apr 2020
Science Editor: Noriyoshi Sawabata Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract

Aim: Laparoscopic anterior esophageal myotomy with a Dor anterior fundoplication is the most commonly performed
surgical myotomy procedure. A lateral esophageal myotomy without an antireflux procedure performed through a left
thoracotomy has been associated with the lowest rate of postoperative gastroesophageal reflux and the highest rate for
relief of dysphagia. The surgical robot allows for the lateral myotomy procedure to be performed by laparoscopy rather
than thoracotomy. We studied our experience with Robotic Lateral Heller Myotomy Without Fundoplication (RLHM) for
achalasia.

Methods: A retrospective review was conducted of the patients with achalasia who underwent RLHM. All patients
completed a subjective dysphagia score questionnaire, received an Eckardt Score, and underwent manometry and pH
testing preoperatively, as well as at 6 and 12 months following the myotomy procedure.

Results: Forty-eight patients underwent RLHM. The median operating room time was 85 min (range 60-132 min).
There was no conversion to a laparotomy. Median hospitalization was 2 days (range 2-3 days). There were no mucosal
perforations, complications, or deaths. Following RLHM, the Lower Esophageal pressure decreased from 35 mmHg (range
18-120 mmHg) to 13.2 mmHg (range 9.8-16.6 mmHg) (P < 0.0001). The length of the Lower Esophageal high-pressure
xone decreased from 5.5 cm (range 4-9 cm) to 2.2 cm (range 1.5-2.8 cm) (P < 0.0001). Two patients (2/48) (4.2%)
had pathologic gastroesophageal reflux. The median acid exposure in all patients was 0.4% (range 0%-17.8%), and the
median Demeester score was 7.5 (range 2-125). The Eckardt score decreased from 6.3 ± 1.8 to 0.8 ± 1.8 at 1 month (P <
0.0001), and 0.8 ± 1.1 at 12 months (P < 0.0001).

Conclusion: RLHM is associated with excellent relief of dysphagia and a low incidence of new gastroesophageal reflux.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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