Laparoendoscopic Single Site Heller Myotomy and Anterior Fundoplication

Laparoendoscopic Single Site (LESS) surgery continues the evolutionary arc from “open” to laparoscopic to “minimal scar” surgery, facilitating improved patient recovery and improved cosmesis. Promises of patient acceptance of LESS surgery are high and will drive investment of resources to promptly develop safe and effective LESS surgery procedures for clinical application.

This video demonstrates LESS Heller myotomy and anterior fundoplication with intraoperative endoscopy in the treatment of achalasia. First, esophagogastroscopy documents the presence of a dilated distal esophagus and a snug gastroesophageal junction. Then, a single 10mm incision is utilized to place three 5mm trocars at the umbilicus: one trocar is utilized for liver retraction, another for an articulating laparoscope, and the third as an operating port. Sutures are placed in the fundus to facilitate exposure. Dissection frees the esophagus from the hiatus laterally and along its ventral surface. Longitudinal muscle fibers are divided with hook electrocautery to provide exposure for division of transverse muscle fibers. Repeat esophagogastroscopy is undertaken to document an adequate myotomy: the scope must pass easily through the gastroesophageal junction, the myotomy must be visualized to cross the squamocolumnar junction (i.e., the z-line), and no esophagotomy / gastrotomy or submucosal burn should be noted. Anterior fundoplication, covering most of the myotomized esophagus, is constructed to provide optimal control of postoperative gastroesophageal reflux.

Laparoendoscopic Single Site Heller myotomy and anterior fundoplication will be embraced by patients, and laparoscopic surgeons will need to meet patient demands.

Session: Podium Video Presentation

Program Number: V011

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