The outcomes of surgical interventions for achalasia treatment improved with the advent
of minimally invasive surgery. Robotic-assisted Heller-Dor's (RAHD) procedure established
over the last years, provides important advantages to surgeons, such as binocular
three-dimensional vision and improvement of fine motor control.Between October and
December of 2022, first in Hungary, 3 patients (37-year-old man, 55- and 72-year-old
women) underwent RAHD procedure for achalasia at the Clinical Centre of the University
of Pécs using the da Vinci Xi system.RAHD procedure was feasible without any particular
problems and the postoperative course of all three patients was uneventful. The operation
times were 198, 204 and 238 minutes, including 23, 19 and 14 minutes for the setup
time of the robot. By the last patient, due to an accompanying hiatal hernia, an additional
hiatal reconstruction was also performed. In the first 2 cases, the patients were
discharged on the 4th postoperative day, while in the last case, with the additional
hiatal reconstruction, the patient was emitted on the 6th postoperative day.There
are several published studies about RAHD cardiomyotomy. The general conclusion is
that, in experienced hands, RAHD procedure is easy to perform, ensures a meticulous
esophageal and gastric myotomy, allowing to visualize and divide each muscle fiber
with a significantly lower rate of mucosal perforations. However, by RAHD procedure,
the overall costs are higher, including a longer operation time during the learning
curve. At the same time, the avoidance of mucosal lacerations and their possible consequences
has to be weighed against the higher overall costs.Laparoscopic cardiomyotomy is the
first standard upper-gastrointestinal operation where a clear advantage of the use
of a surgical robot has been proven. Thus, wherever this equipment is available, it
should be preferred for this procedure. Orv Hetil. 2023; 164(14): 542-547.
