Contemporary Operative Trends and Outcomes of Laparoscopic and Robotic Heller Myotomy Using a Large National Database

BackgroundRobotic-assisted Heller myotomy (RAHM) is increasingly utilized for the surgical treatment of achalasia. While prior studies have suggested potential technical advantages of RAHM over laparoscopic Heller myotomy (LHM), the economic implications remain less well-defined. This study aimed to compare hospitalization costs and clinical outcomes between RAHM and LHM using a nationally representative cohort.MethodsThe 2016-2021 Nationwide Readmission Database was utilized to identify adult patients ((≥18 years) undergoing either LHM or RAHM for achalasia. Entropy balancing on key variables followed by multivariable linear regression analysis was used to elucidate the association between LHM and RHM on outcomes, including mortality, 30-day readmission, hospitalization costs, and length of stay (LOS).ResultsAmong 14 662 patients, 30.5% underwent RAHM. While use of RAHM increased over the study period, LHM remained the most frequently performed approach. There were no significant differences in mortality (0.25% vs 0.19%, <i>P</i> = 0.64), LOS (3.1 vs 3.0 days, <i>P</i> = 0.09), or 30-day readmissions (4.86% vs 4.88%, <i>P</i> = 0.98) between RAHM and LHM. However, index hospitalization costs were higher for RAHM ($19,387 vs $16,317, <i>P</i> < 0.001), and this cost difference persisted after adjustment (β +$3,345, 95% CI $2473-$4,217, <i>P</i> < 0.001).ConclusionRobotic-assisted Heller myotomy and LHM demonstrate equivalent short-term clinical outcomes for achalasia. However, RAHM is consistently associated with higher hospitalization costs, warranting further evaluation of its economic impact.