Outcomes of Robotic vs Laparoscopic Heller Myotomy

BACKGROUND: Robotic surgery benefits include binocular vision, increased dexterity, and adjustable hand control speed. We hypothesized perforation rate of robotic Heller myotomy (RH) was lower than that of laparoscopic Heller myotomy (LH). STUDY DESIGN: A retrospective cohort study of a prospectively maintained database of 135 patients diagnosed with achalasia or esophagogastric junction outlet obstruction who underwent Heller myotomy by a single surgeon was identified for inclusion. After exclusions, 107 patients were analyzed. The primary outcome was the intraoperative perforation rate. Secondary outcomes included length of stay, short- and long-term GERD Health-Related Quality of Life (GERD-HRQL), dysphagia, and Eckardt scores. Results are expressed as mean ± SD, and statistical analysis was performed with GraphPad Prism (10.4.2). RESULTS: RH had a lower rate of intraoperative perforation (n = 0), compared with LH (n = 3; 13.6%; p < 0.01). The median length of stay was shorter for the RH group 1 day vs 2 days for LH (p < 0.01). RH and LH significantly improved both GERD-HRQL and Eckardt scores in short- and long-term follow-up. Long-term success (Eckardt score ≤ to 3) was achieved in 88% of LH and RH. CONCLUSIONS: Robotic surgery allows for a safer myotomy with a significant reduction in intraoperative perforation rate and in length of stay. Robotic surgery enhanced the surgeon's performance of an extended myotomy, resulting in long-term success of RH. RH has lower complication rates and is superior to LH and is our technique of choice.