Abstract：
OBJECTIVE: To describe the experience of the robotic approach for achalasia surgery in a tertiary center.
METHODS: Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed.
RESULTS: 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller\'s myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211minutes. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered.
CONCLUSIONS: In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.
METHODS: Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed.
RESULTS: 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller\'s myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211minutes. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered.
CONCLUSIONS: In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.
摘要：
目的：描述三级中心机器人入路贲门失弛缓症手术的经验。
方法：对2010年5月至2019年4月接受机器人手术的贲门失弛缓症患者进行分析。在前瞻性数据库中收集研究变量并进行描述性分析。
结果：纳入45例患者（55.6%为男性），平均年龄44岁。诊断时的主要症状是吞咽困难。19例患者（42.2%）在手术前接受内镜治疗，主要是气动膨胀（84.2%）。与Toupet胃底折叠术相关的Heller肌切开术是首选的手术技术，平均手术时间211分钟.平均停留5天。术后穿孔2例（4.4%）。围手术期死亡率为0%。平均随访时间为64个月。在3年和5年，观察到Eckardt评分显着降低，测压研究显示，休息时食管下括约肌压力降低58％和70％，分别,食道体持续运动不足。2例(5.4%)患者诊断为病理性胃食管反流,4例(10.8%)患者出现症状复发,需要内窥镜气动扩张。在两种情况下，扩张没有效果,所以考虑了内镜下肌切开术。
结论：根据我们的经验，机器人手术是治疗贲门失弛缓症安全有效的方法。
方法：对2010年5月至2019年4月接受机器人手术的贲门失弛缓症患者进行分析。在前瞻性数据库中收集研究变量并进行描述性分析。
结果：纳入45例患者（55.6%为男性），平均年龄44岁。诊断时的主要症状是吞咽困难。19例患者（42.2%）在手术前接受内镜治疗，主要是气动膨胀（84.2%）。与Toupet胃底折叠术相关的Heller肌切开术是首选的手术技术，平均手术时间211分钟.平均停留5天。术后穿孔2例（4.4%）。围手术期死亡率为0%。平均随访时间为64个月。在3年和5年，观察到Eckardt评分显着降低，测压研究显示，休息时食管下括约肌压力降低58％和70％，分别,食道体持续运动不足。2例(5.4%)患者诊断为病理性胃食管反流,4例(10.8%)患者出现症状复发,需要内窥镜气动扩张。在两种情况下，扩张没有效果,所以考虑了内镜下肌切开术。
结论：根据我们的经验，机器人手术是治疗贲门失弛缓症安全有效的方法。
