• Ilan Schrier, Yael Feferman, Yael Berger, Dafna Yahav, Eran Sadot, Omri Sulimani, Michael Stein, and Hanoch Kashtan.
• Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
• Isr Med Assoc J. 2021 Oct 1; 23 (10): 631-634.

BackgroundSurgical myotomy is the best therapeutic option for patients with achalasia. The minimally invasive technique is considered to be the preferred method for many surgeons. Robotic-assisted laparoscopic myotomy has several advantages over conventional laparoscopic surgery. These benefits include more accurate incisions that may result in a lower rate of intra-operative complications.ObjectivesTo describe our technique of performing robotic-assisted Heller myotomy and to review the initial results of this procedure.MethodsAll patients undergoing robotic-assisted Heller myotomy for achalasia between the years 2012-2018 at Rabin Medical Center were retrospectively reviewed from our institutional prospective database.ResultsThirty patients underwent robotic-assisted Heller myotomy for achalasia. Mean operative time was 77 minutes (range 47-109 minutes) including docking time of the robotic system. There were no cases of conversion to laparoscopic or open surgery. There were no cases of intra-operative perforation of the mucosa. None of the patients had postoperative morbidity or mortality. Good postoperative results were achieved in 25 patients. Four patients required additional intervention (3 had endoscopic dilatations and 1 with known preoperative endstage achalasia had undergone esophagectomy). One patient was lost to follow-up.ConclusionsRobotic-assisted Heller myotomy is a safe technique with a low incidence of intra-operative esophageal perforation compared to the laparoscopic approach. We believe that robotic-assisted surgery should be the procedure of choice to treat achalasia.

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