Indocyanine Green Fluorescence During Laparoscopic and Robotic Heller Dor Myotomy for Achalasia: A Scoping Review

Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and absence of esophageal peristalsis. Laparoscopic or robotic Heller myotomy with fundoplication remains the standard surgical treatment. Ensuring the completeness of the myotomy and identifying possible mucosal perforations intraoperatively are crucial for optimal outcomes. Traditionally, intraoperative endoscopy and air leak testing are used to confirm mucosal integrity and adequate myotomy. Recently, near-infrared fluorescence imaging using indocyanine green (ICG) has been proposed as an alternative intraoperative tool to assess mucosal integrity and identify residual muscle fibers during Heller myotomy. However, the available literature on this technique is limited and mainly consists of small case series and technical reports. The aim of this scoping review is to map the available evidence regarding the use of indocyanine green fluorescence during laparoscopic or robotic Heller myotomy for achalasia.