Laparoscopic robotic-assisted Heller procedure for esophageal achalasia
Epublication WebSurg.com, Oct 2006;06(10). URL: http://websurg.com/doi/vd01en2007
This video demonstrates a robotic-assisted Heller procedure for treatment of esophageal achalasia. The surgeon starts by dissecting the gastroesophageal junction. The mobilization of the stomach is limited to the anterior and lateral aspect, leaving the posterior attachments intact. The myotomy is started just above the gastroesophageal junction and extended 6 cm proximally and 2 cm distally onto the stomach using robotic articulated scissors. The extension of the myotomy on the gastric side continues to be the most difficult part of the dissection. The change in direction of the muscular fibers, from circular at the esophagus, to oblique at the stomach, makes it difficult to develop the necessary submucosal plane for dividing the muscular fibers. The video demonstrates the freedom of movement of the articulated robotic instruments that allow the surgeon to divide each individual muscular fiber achieving a precise dissection of the gastroesophageal junction. Once the myotomy is completed a standard Dor Fundoplication is performed.