Robotic cricopharyngeal myotomy for the treatment of cricopharyngeal bars.

INTRODUCTION

Failure of the cricopharyngeal muscle to relax leads to the formation of a cricopharyngeal (CP) bar which causes dysphagia and increased risk for aspiration. Open myotomy is one definitive treatment option; however, there are several drawbacks including a long neck incision, possible drain placement, and invasiveness of the procedure. We aim to share an updated dataset of our experience using the DaVinci robotic platform to perform a minimally invasive CP myotomy, which has never been described before prior to our original dataset.

METHODS

We performed a retrospective review of consecutive robotic CP myotomies performed in adult patients by a single surgeon from August 2021 to March 2024. Outcomes of interest included length of procedure, time to diet resumption, hospital length of stay, complications, symptom improvement at follow-up, and symptom recurrence.

RESULTS

Twenty-five robotic CP myotomies were performed. The median age was 72 years old (62-91) and near evenly split between sexes (n = 13 female, 52%) with a median BMI of 28.5 kg/m (17.7-39.5). The median procedure length was 111 min (75-141), and there were no intraoperative complications. All patients underwent a post-procedural esophagram with no leaks identified. All patients were started on a full liquid diet in the recovery room prior to discharge. Same-day discharge rate was 88%. Symptom resolution was reported in 23/24 patients (95.8%) who completed post-operative follow-up. There was one delayed subacute hematoma with wound dehiscence but no other complications and no readmissions. Two patients reported recurrent symptoms but only one with radiographic evidence of a recurrent cricopharyngeal bar.

CONCLUSION

Robotic cricopharyngeal myotomy represents a promising treatment for cricopharyngeal bars with cervical dysphagia with encouraging safety and efficacy.