Division of Esophageal Surgery Regional Referral Center "Mauro Rossi" for Diagnosis and Treatment of Diseases of Esophagus, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy.
Division of Radiology, Department of Radiology, Vascular and Interventional Radiology and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy.
Updates Surg. 2021 Dec;73(6):2247-2252. doi: 10.1007/s13304-021-01092-6. Epub 2021 May 24.
Achalasia is a rare motility disorder of the esophagus. According to the Chicago Classification criteria, there are three clinical types of Achalasia and the treatment is patient-tailored. Laparoscopic Heller-Dor is the gold-standard treatment for the most frequent types of Achalasia. However, robotic surgery is able to combine the clinical advantages of minimally invasive surgery with a powerful dexterity on complex anatomic structures. The aim of this study is to report the institutional experience developed in a referral center of esophageal surgery in the treatment of Achalasia by Robotic Heller-Dor. We retrospectively analyzed data of patients that consecutively underwent Robotic Heller-Dor at our institution between January 2012 and January 2020 using the Da Vinci Surgical System. Sixty-nine patients underwent Robotic Heller-Dor. Among the patients, 35 (51%) were classified as type I, 29 (42%) as type II, and 5 (7%) as type III. The Da Vinci SI HD Surgical System and the Da Vinci XI HD Surgical System were used in 56 (81%) and 13 (19%) patients, respectively. No mucosal perforation was observed and post-operative mortality was absent. The mean follow-up was 23.3 months (6-84). Ten patients (14.5%) reported post-operative complaints. In our opinion, Robotic Heller-Dor is an effective tool in the treatment of Achalasia. Robotic Heller-Dor may be a suitable procedure for learning and teaching robotic surgery in the perspective of pursing more complex esophago-gastric surgical procedures.
贲门失弛缓症是一种罕见的食管动力障碍。根据芝加哥分类标准，贲门失弛缓症有三种临床类型，治疗方法因人而异。腹腔镜 Heller-Dor 是最常见类型贲门失弛缓症的金标准治疗方法。然而，机器人手术能够将微创手术的临床优势与对复杂解剖结构的强大灵巧性相结合。本研究旨在报告在食管外科转诊中心应用机器人 Heller-Dor 治疗贲门失弛缓症的机构经验。我们回顾性分析了 2012 年 1 月至 2020 年 1 月期间在我院接受机器人 Heller-Dor 治疗的患者数据，使用达芬奇手术系统。69 例患者接受了机器人 Heller-Dor 治疗。其中 35 例（51%）为 I 型，29 例（42%）为 II 型，5 例（7%）为 III 型。56 例（81%）患者使用了达芬奇 SI HD 手术系统，13 例（19%）患者使用了达芬奇 XI HD 手术系统。未观察到黏膜穿孔，无术后死亡。平均随访时间为 23.3 个月（6-84）。10 例（14.5%）患者报告术后有不适。我们认为，机器人 Heller-Dor 是治疗贲门失弛缓症的有效工具。机器人 Heller-Dor 可能是学习和教授机器人手术的合适方法，因为它可以追求更复杂的食管胃手术。
