Early outcomes of robotic Heller’s cardiomyotomy: First report from central India

INTRODUCTION: Achalasia cardia is a rare oesophageal motility disorder characterised by the inability of the lower oesophageal sphincter to relax. The gold standard of care being surgical cardiomyotomy, the robotic approach is becoming more popular, over the last decade. This study evaluates the early outcomes of robotic Heller's cardiomyotomy performed at a single centre in central India. PATIENTS AND METHODS: A retrospective data analysis of all the patients of achalasia cardia who underwent robotic cardiomyotomy from March 2024 to June 2025 was done. All the patients were operated using the SSi Mantra™ surgical robotic system (SSI Innovations International Inc., Gurugram). Patient demographics, high-resolution manometry findings, pre-operative Eckardt scores, docking and total console times were noted. RESULTS: Eleven patients were included in the study. Median age was 36 years (range 20-63 years), with males comprising 54.5%. Mean body mass index was 21.4 ± 2.2. Type 2 achalasia was found in 63.6% of patients. The median pre-operative integrated relaxation pressure was 28 mmHg. Mean docking and console time were 12.5 ± 7.4 min and 130.7 ± 34.2 min, respectively. The improvement of the Eckhardt score was from median score of 8 to 1 (P < 0.05). CONCLUSION: The magnified vision, precision and improved instrument manoeuvrability provided by the robotic platform help in improved patient outcomes. The modular design of the SSi Mantra™ surgical robotic system allows for better ergonomics, making it a viable platform for performing robotic Heller's cardiomyotomy. The initial outcomes appear comparable to those achieved with other robotic systems. Larger studies are needed to further evaluate these potential benefits.