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Laparoscopic Heller procedure for achalasia
This is a 'live' surgery performed by Dr. B Dallemagne demonstrating the key steps in performing a Heller procedure. Minimal dissection is carried out to expose the anterior surface of the esophagus, after which the myotomy is delicately performed with scissors. This video is recommended to upper GI surgeons.
Barium swallow showed the classic sign of achalasia at the level of the cardia in this elderly woman with gastroesophageal reflux disease. CT-scan of the chest showed a large sigmoid-like esophagus. Mobilization of the esophagus begins with the authors opening only the anterior aspect of the hiatus to gain access to the esophagus. They dissect the upper part of the esophagus and expose the azygos vein on the right, clearing the gastroesophageal junction on the gastric side of the cardia. They continue by opening the hypertrophic musculature to enable swallowing, then continue with a Heller myotomy.
B Dallemagne, J Marescaux
Surgical intervention
11 years ago
641 views
126 likes
0 comments
11:59
Laparoscopic Heller procedure for achalasia
This is a 'live' surgery performed by Dr. B Dallemagne demonstrating the key steps in performing a Heller procedure. Minimal dissection is carried out to expose the anterior surface of the esophagus, after which the myotomy is delicately performed with scissors. This video is recommended to upper GI surgeons.
Barium swallow showed the classic sign of achalasia at the level of the cardia in this elderly woman with gastroesophageal reflux disease. CT-scan of the chest showed a large sigmoid-like esophagus. Mobilization of the esophagus begins with the authors opening only the anterior aspect of the hiatus to gain access to the esophagus. They dissect the upper part of the esophagus and expose the azygos vein on the right, clearing the gastroesophageal junction on the gastric side of the cardia. They continue by opening the hypertrophic musculature to enable swallowing, then continue with a Heller myotomy.
Laparoscopic robotic-assisted Heller procedure for esophageal achalasia
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.
B Dallemagne
Surgical intervention
12 years ago
607 views
59 likes
0 comments
12:18
Laparoscopic robotic-assisted Heller procedure for esophageal achalasia
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.