Robotic esophagomyotomy for achalasia: technical note and review of the literature

Abstract

INTRODUCTION: The treatment of achalasia has undergone a continuous evolution with the advancement of technology. Since the beginning of the new millennium, the employment of robotics has led to technical facilitation with the execution of the myotomy and consequently to an improvement of the outcomes and a decrease in perioperative morbidity. EVIDENCE ACQUISITION: We provide a detailed description of the surgical procedure and the perioperative management together with a literature search of Electronic PubMed/Medline database and Cochrane Library. English written studies on robotic assisted myotomy (case reports, reviews, single arm and comparative studies) were included. Between 2001 and 2020, 10 case reports, 13 single arm studies, 10 comparative studies, 2 meta-analysis, 11 reviews and 2 technical notes on robotic assisted esophagomyotomy for achalasia were published. EVIDENCE SYNTHESIS: As reported by the studies available in the literature and evaluated in this manuscript, robotic assisted cardiomyotomy seems not only feasible but also a safer operation compared with traditional laparoscopic Heller myotomy, due to a significant lower incidence of intraoperative esophageal perforation. CONCLUSIONS: Also if large and randomized controlled studies are advocated, robotic assisted esophago-cardiomyotomy might be considered superior to laparoscopic Heller myotomy that, until now, is mostly considered the gold standard in the surgical treatment of achalasia.