Robotic Heller Myotomy With Intraoperative Endoscopy For Assessment
Nguyen M. Le, MD, Paul C. Lee, MD.
Northwell Health, New York, NY, USA.
OBJECTIVE: This video demonstrates a robotic-assisted Heller myotomy with Toupet fundoplication. We use intraoperative endoscopy to assess adequacy of myotomy length.
METHODS: A 19-year-old male with dysphagia was recently diagnosed with achalasia both on barium swallow as well as manometry. Because of his young age, the decision was to proceed with robotic-assisted Heller myotomy. The patient was approached in supine position with four ports for robot and one 5-mm liver retractor. Once the myotomy was completed, endoscopy was used to assess the adequacy of myotomy length. With satisfactory length, we then proceeded with the Toupet fundoplication. The procedure was performed without complication and endoscopy helped us to ensure adequate myotomy length.
RESULTS: Barium swallow on POD1 showed no evidence of obstruction or leak. He was advanced to clear liquid diet and discharged home on that same day. Two-week postoperative visit showed marked improvement in his dysphagia, tolerating regular oral diet.
CONCLUSIONS: Robotic-assisted Heller myotomy with Toupet fundoplication continues to be a safe and effective surgery for the management of achalasia. Intraoperative endoscopy is an important tool to help us confirm adequate length of myotomy.
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