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Robotic Heller Myotomy Decreases Esophageal Perforations

Abstracts
2002 Digestive Disease Week

# 108282 Abstract ID: 108282 Robotic Heller Myotomy Decreases Esophageal Perforations
Santiago Horgan, Fernando Elli, Robert Berger, Scott Melvin, Chicago, IL; Columbus, OH

Background: We present a case series of the first 30 robotic Heller myotomies using the da Vinci Surgical System (tm) which was approved for clinical use in 2000. The surgeries were performed in two different university institutions. Several recent studies have reviewed the outcomes of surgical therapy following prior pneumatic dilation and/or botulinum toxin injections; these have shown an increased risk of mucosal perforation varying from 2.4% to 13%. Design: History was obtained and specifically noted whether the patients prior endoscopic therapy included pneumatic dilation and/or botulinum toxin injection therapy. Using the da Vinci Surgical System (tm), a Heller myotomy with Dor fundoplication was performed by single surgeons at two university hospitals. Operative notes and hospital discharge summaries were reviewed for evidence of esophageal perforation at the time of surgery. Results: Thirty patients, ages 18 to 64, underwent robotic Heller myotomy. Twenty-five of thirty patients (85%) had prior endoscopic therapy. Fourteen patients had only pneumatic dilation, ten patients had botulinum toxin injections and pneumatic dilations, one additional patient had a previous myotomy through a thoracic approach. No patients had botulinum toxin injection alone. Average hospital stay was 1.1 days and estimated blood loss was minimal. Operating room time was 160 minutes with myotomy time averaging 24 minutes. There were no reports of mucosal perforations occurring during surgery. Conclusion: Early data suggest the use of the da Vinci Surgical System (tm) for technically challenging and demanding surgery may decrease the morbidity of mucosal perforation following prior endoscopic therapy, that has a reported 10 % perforation incidence following laparoscopic or open surgery. We attribute our results, of 0% perforation, to the improved image afforded by the magnification and 3-D view. In addition, the articulating instruments of the system allow a precise dissection of the esophageal muscle fibers from the mucosa.




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