Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders
Abstract Background Video-assisted laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. While robotic surgery offering some specific advantages such as better three-dimensional (3D) stereoscopic vision, hand-eye consistency, and flexibility and stability with the...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-023-02202-4 |
| _version_ | 1797630474029367296 |
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| author | Xun Jiang Chunlin Ye Lei Jiang Guangxia Wei Shaohua Dai Yong Xi Zhiguo Chen Bentong Yu Jian Tang |
| author_facet | Xun Jiang Chunlin Ye Lei Jiang Guangxia Wei Shaohua Dai Yong Xi Zhiguo Chen Bentong Yu Jian Tang |
| author_sort | Xun Jiang |
| collection | DOAJ |
| description | Abstract Background Video-assisted laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. While robotic surgery offering some specific advantages such as better three-dimensional (3D) stereoscopic vision, hand-eye consistency, and flexibility and stability with the endowrist is expected to be shorter in learning curve than that of LHM for surgeons who are proficient in LHM. The aim of this study was to describe a single surgeon’s experience related to the transition from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication. Methods We conducted a retrospective observational study based on the recorded data of the first 66 Heller myotomy performed with laparoscopic Heller myotomy with Dor fundoplication (LHMD, 26 cases) and with the robotic Heller myotomy with Dor fundoplication (RHMD, 40 cases) by the same surgeon in Department of Thoracic Surgery of The First Affiliated Hospital of Nanchang University in China. The operation time and intraoperative blood loss were analyzed using the cumulative sum (CUSUM) method. Corresponding statistical tests were used to compare outcomes of both serials of cases. Results The median operation time was shorter in the RHMD group compared to the LHMD group (130 [IQR 123–141] minutes vs. 163 [IQR 153–169]) minutes, p < 0.001). In the RHMD group, one patient (2.5%) experienced mucosal perforation, whereas, in the LHMD group, the incidence of this complication was significantly higher at 19.2% (5 patients) (p = 0.031). Based on cumulative sum analyses, operation time decreased starting with case 20 in the LHMD group and with case 18 in the RHMD group. Intraoperative blood loss tended to decline starting with case 19 in the LHMD group and with case 16 in the RHMD group. Conclusions Both RHMD and LHMD are effective surgical procedures for symptom relief of achalasia patients. RHMD demonstrates superior outcomes in terms of operation time and mucosal perforation during surgery compared to LHMD. Proficiency with RHMD can be achieved after approximately 16–18 cases, while that of LHMD can be obtained after around 19–20 cases. |
| first_indexed | 2024-03-11T11:08:37Z |
| format | Article |
| id | doaj.art-9f694794d73247efb5eee23bec75e0ac |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-03-11T11:08:37Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-9f694794d73247efb5eee23bec75e0ac2023-11-12T12:05:09ZengBMCBMC Surgery1471-24822023-11-0123111010.1186/s12893-023-02202-4Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disordersXun Jiang0Chunlin Ye1Lei Jiang2Guangxia Wei3Shaohua Dai4Yong Xi5Zhiguo Chen6Bentong Yu7Jian Tang8Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityDepartment of Thoracic Surgery, The First Affiliated Hospital of Nanchang UniversityAbstract Background Video-assisted laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. While robotic surgery offering some specific advantages such as better three-dimensional (3D) stereoscopic vision, hand-eye consistency, and flexibility and stability with the endowrist is expected to be shorter in learning curve than that of LHM for surgeons who are proficient in LHM. The aim of this study was to describe a single surgeon’s experience related to the transition from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication. Methods We conducted a retrospective observational study based on the recorded data of the first 66 Heller myotomy performed with laparoscopic Heller myotomy with Dor fundoplication (LHMD, 26 cases) and with the robotic Heller myotomy with Dor fundoplication (RHMD, 40 cases) by the same surgeon in Department of Thoracic Surgery of The First Affiliated Hospital of Nanchang University in China. The operation time and intraoperative blood loss were analyzed using the cumulative sum (CUSUM) method. Corresponding statistical tests were used to compare outcomes of both serials of cases. Results The median operation time was shorter in the RHMD group compared to the LHMD group (130 [IQR 123–141] minutes vs. 163 [IQR 153–169]) minutes, p < 0.001). In the RHMD group, one patient (2.5%) experienced mucosal perforation, whereas, in the LHMD group, the incidence of this complication was significantly higher at 19.2% (5 patients) (p = 0.031). Based on cumulative sum analyses, operation time decreased starting with case 20 in the LHMD group and with case 18 in the RHMD group. Intraoperative blood loss tended to decline starting with case 19 in the LHMD group and with case 16 in the RHMD group. Conclusions Both RHMD and LHMD are effective surgical procedures for symptom relief of achalasia patients. RHMD demonstrates superior outcomes in terms of operation time and mucosal perforation during surgery compared to LHMD. Proficiency with RHMD can be achieved after approximately 16–18 cases, while that of LHMD can be obtained after around 19–20 cases.https://doi.org/10.1186/s12893-023-02202-4Heller myotomyLaparoscopic Heller myotomy with Dor fundoplicationRobotic Heller myotomy with Dor fundoplicationLearning curve |
| spellingShingle | Xun Jiang Chunlin Ye Lei Jiang Guangxia Wei Shaohua Dai Yong Xi Zhiguo Chen Bentong Yu Jian Tang Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders BMC Surgery Heller myotomy Laparoscopic Heller myotomy with Dor fundoplication Robotic Heller myotomy with Dor fundoplication Learning curve |
| title | Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders |
| title_full | Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders |
| title_fullStr | Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders |
| title_full_unstemmed | Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders |
| title_short | Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders |
| title_sort | single center experience of transitioning from video assisted laparoscopic to robotic heller myotomy with dor fundoplication for esophageal motility disorders |
| topic | Heller myotomy Laparoscopic Heller myotomy with Dor fundoplication Robotic Heller myotomy with Dor fundoplication Learning curve |
| url | https://doi.org/10.1186/s12893-023-02202-4 |
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