Short-term outcomes and learning curve of the robot-assisted Heller-Dor myotomy for achalasia of cardia: A single-center retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YE Chunlin ¹ , WEI Guangxia ¹ , XU Kaiying ¹ , JIANG Lei ¹ , XU Bin ¹ , LI Quanjin ¹ , HU Zhi ² ,  YU Bentong ¹ ,  TANG Jian ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China;
2. Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China;

Corresponding author：

YU Bentong, Email: yubentong@126.com; TANG Jian, Email: rometangjian@hotmail.com

Keywords：

Achalasia of cardia; Heller myotomy; fundoplication; robot-assisted surgery

DOI：

10.7507/1007-4848.202110055

Video：

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Objective To investigate short-term outcomes of robot-assisted Heller-Dor myotomy (RAHM-Dor) for achalasia of cardia and our learning curve experience. Methods The clinical data and recent follow-up results of 42 patients who received RAHM-Dor from November 2015 to January 2020 in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed, including 20 males and 22 females with a mean age of 40.8±18.4 years. Results Dysphagia was the most common symptom, followed by heartburn and regurgitation. The mean operation time was 122.8±23.9 min. The mean blood loss was 47.5±32.7 mL. Two patients suffered mucosal injury, and successfully repaired by suturing during surgery. There was no esophageal fistula, conversion to an open operation or perioperative death in this series. The median length of hospital stay was 8 (6, 9) d. In all patients, the Stooler and Eckardt scores of postoperative 1, 6 and 12 months decreased compared to those of pre-operation (P<0.001). Conclusion RAHM-Dor is a safe and feasible avenue for the treatment of achalasia of cardia, and can achieve a satisfying short-term results. The learning curve shows a transition to the standard stage from the learning stage after 16-18 operations.

Citation： YE Chunlin, WEI Guangxia, XU Kaiying, JIANG Lei, XU Bin, LI Quanjin, HU Zhi, YU Bentong, TANG Jian. Short-term outcomes and learning curve of the robot-assisted Heller-Dor myotomy for achalasia of cardia: A single-center retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(4): 443-448. doi: 10.7507/1007-4848.202110055 Copy

1.	Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet, 2014, 383(9911): 83-93.
2.	Romero-Hernández F, Furuzawa-Carballeda J, Hernández-Molina G, et al. Autoimmune comorbidity in achalasia patients. J Gastroenterol Hepatol, 2018, 33(1): 203-208.
3.	Vaezi MF, Pandolfino JE, Yadlapati RH, et al. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol, 2020, 115(9): 1393-1411.
4.	Heller E. Extramukose kardioplastik beim chronishen kardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir, 1914, 27: 141-149.
5.	Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb, 1991, 36(3): 152-154.
6.	Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: Diagnosis and management of achalasia. Am J Gastroenterol, 2013, 108(8): 1238-1249.
7.	Vaezi MF, Felix VN, Penagini R, et al. Achalasia: From diagnosis to management. Ann N Y Acad Sci, 2016, 1381(1): 34-44.
8.	Tebaibia A, Boudjella MA, Boutarene D, et al. Incidence, clinical features and para-clinical findings of achalasia in Algeria: Experience of 25 years. World J Gastroenterol, 2016, 22(38): 8615-8623.
9.	Sadowski DC, Ackah F, Jiang B, et al. Achalasia: Incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil, 2010, 22(9): e256-e261.
10.	Enestvedt BK, Williams JL, Sonnenberg A. Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther, 2011, 33(11): 1209-1214.
11.	Dimitriu A, Gheorghe C. High resolution manometry—A mandatory examination in the pre and postoperative assessment of patients with achalasia. Chirurgia (Bucur), 2018, 113(1): 61-69.
12.	Shaligram A, Unnirevi J, Simorov A, et al. How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia. Surg Endosc, 2012, 26(4): 1047-1050.
13.	Litle VR. Laparoscopic Heller myotomy for achalasia: A review of the controversies. Ann Thorac Surg, 2008, 85(2): S743-S746.
14.	Xie J, Vatsan MS, Gangemi A. Laparoscopic versus robotic-assisted Heller myotomy for the treatment of achalasia: A systematic review with meta-analysis. Int J Med Robot, 2021, 17(4): e2253.
15.	Kim SS, Guillen-Rodriguez J, Little AG. Optimal surgical intervention for achalasia: Laparoscopic or robotic approach. J Robot Surg, 2019, 13(3): 397-400.
16.	Park CH, Jung DH, Kim DH, et al. Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: A meta-analysis. Gastrointest Endosc, 2019, 90(4): 546-558.
17.	Mundre P, Black CJ, Mohammed N, et al. Efficacy of surgical or endoscopic treatment of idiopathic achalasia: A systematic review and network meta-analysis. Lancet Gastroenterol Hepatol, 2021, 6(1): 30-38.
18.	Schlottmann F, Luckett DJ, Fine J, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: A systematic review and meta-analysis. Ann Surg, 2018, 267(3): 451-460.
19.	Werner YB, Hakanson B, Martinek J, et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med, 2019, 381(23): 2219-2229.
20.	Moura ET, Farias GF, Coutinho LM, et al. A randomized controlled trial comparing peroral endoscopic myotomy (POEM) versus laparoscopic heller myotomy with fundoplication in the treatment of achalasia. Gastrointest Endosc 2019, 89: AB84. .
21.	Gockel I, Junginger T, Eckardt VF. Persistent and recurrent achalasia after Heller myotomy: Analysis of different patterns and long-term results of reoperation. Arch Surg, 2007, 142(11): 1093-1097.
22.	Galvani C, Gorodner MV, Moser F, et al. Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc, 2006, 20(7): 1105-1112.
23.	Huffmanm LC, Pandalai PK, Boulton BJ, et al. Robotic Heller myotomy: A safe operation with higher postoperative quality-of-life indices. Surgery, 2007, 142(4): 613-618.
24.	Mandovra P, Kalikar V, Patel A, et al. Redo laparoscopic Heller's cardiomyotomy for recurrent achalasia: Is laparoscopic surgery feasible? J Laparoendosc Adv Surg Tech A, 2018, 28(3): 298-301.

1. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet, 2014, 383(9911): 83-93.
2. Romero-Hernández F, Furuzawa-Carballeda J, Hernández-Molina G, et al. Autoimmune comorbidity in achalasia patients. J Gastroenterol Hepatol, 2018, 33(1): 203-208.
3. Vaezi MF, Pandolfino JE, Yadlapati RH, et al. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol, 2020, 115(9): 1393-1411.
4. Heller E. Extramukose kardioplastik beim chronishen kardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir, 1914, 27: 141-149.
5. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb, 1991, 36(3): 152-154.
6. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: Diagnosis and management of achalasia. Am J Gastroenterol, 2013, 108(8): 1238-1249.
7. Vaezi MF, Felix VN, Penagini R, et al. Achalasia: From diagnosis to management. Ann N Y Acad Sci, 2016, 1381(1): 34-44.
8. Tebaibia A, Boudjella MA, Boutarene D, et al. Incidence, clinical features and para-clinical findings of achalasia in Algeria: Experience of 25 years. World J Gastroenterol, 2016, 22(38): 8615-8623.
9. Sadowski DC, Ackah F, Jiang B, et al. Achalasia: Incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil, 2010, 22(9): e256-e261.
10. Enestvedt BK, Williams JL, Sonnenberg A. Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther, 2011, 33(11): 1209-1214.
11. Dimitriu A, Gheorghe C. High resolution manometry—A mandatory examination in the pre and postoperative assessment of patients with achalasia. Chirurgia (Bucur), 2018, 113(1): 61-69.
12. Shaligram A, Unnirevi J, Simorov A, et al. How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia. Surg Endosc, 2012, 26(4): 1047-1050.
13. Litle VR. Laparoscopic Heller myotomy for achalasia: A review of the controversies. Ann Thorac Surg, 2008, 85(2): S743-S746.
14. Xie J, Vatsan MS, Gangemi A. Laparoscopic versus robotic-assisted Heller myotomy for the treatment of achalasia: A systematic review with meta-analysis. Int J Med Robot, 2021, 17(4): e2253.
15. Kim SS, Guillen-Rodriguez J, Little AG. Optimal surgical intervention for achalasia: Laparoscopic or robotic approach. J Robot Surg, 2019, 13(3): 397-400.
16. Park CH, Jung DH, Kim DH, et al. Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: A meta-analysis. Gastrointest Endosc, 2019, 90(4): 546-558.
17. Mundre P, Black CJ, Mohammed N, et al. Efficacy of surgical or endoscopic treatment of idiopathic achalasia: A systematic review and network meta-analysis. Lancet Gastroenterol Hepatol, 2021, 6(1): 30-38.
18. Schlottmann F, Luckett DJ, Fine J, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: A systematic review and meta-analysis. Ann Surg, 2018, 267(3): 451-460.
19. Werner YB, Hakanson B, Martinek J, et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med, 2019, 381(23): 2219-2229.
20. Moura ET, Farias GF, Coutinho LM, et al. A randomized controlled trial comparing peroral endoscopic myotomy (POEM) versus laparoscopic heller myotomy with fundoplication in the treatment of achalasia. Gastrointest Endosc 2019, 89: AB84. .
21. Gockel I, Junginger T, Eckardt VF. Persistent and recurrent achalasia after Heller myotomy: Analysis of different patterns and long-term results of reoperation. Arch Surg, 2007, 142(11): 1093-1097.
22. Galvani C, Gorodner MV, Moser F, et al. Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc, 2006, 20(7): 1105-1112.
23. Huffmanm LC, Pandalai PK, Boulton BJ, et al. Robotic Heller myotomy: A safe operation with higher postoperative quality-of-life indices. Surgery, 2007, 142(4): 613-618.
24. Mandovra P, Kalikar V, Patel A, et al. Redo laparoscopic Heller's cardiomyotomy for recurrent achalasia: Is laparoscopic surgery feasible? J Laparoendosc Adv Surg Tech A, 2018, 28(3): 298-301.

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Short-term outcomes and learning curve of the robot-assisted Heller-Dor myotomy for achalasia of cardia: A single-center retrospective study

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