Robotic Heller myotomy and fundoplication - techniques and outcomes

Achalasia, a primary esophageal motility disorder characterized by impaired peristalsis and the inability of the lower esophageal sphincter to relax, affects approximately 0.5-1.2 individuals per 100,000 annually. Traditional treatments have included endoscopic interventions and Heller myotomy with partial fundoplication, long regarded as the gold-standard surgical option. The advent of minimally invasive techniques, particularly robotic Heller myotomy performed since 2001, has introduced significant advancements in the treatment of achalasia. This review examines the evolution of Heller myotomy, focusing on the robotic approach, which offers distinct advantages such as enhanced surgical precision, a lower risk of mucosal perforation, and shorter hospital stays. By comparing robotic-assisted Heller myotomy (RAHM) with laparoscopic and open approaches, this review underscores the effectiveness of the robotic method in improving operative outcomes and offering a safer, more efficient treatment for patients with achalasia. Through an overview of diagnostic strategies, surgical techniques, and postoperative management, this review underscores the growing role of RAHM as a pivotal shift toward optimizing care for patients with this complex esophageal disorder.