James Kurtz, Joseph Lim, Rene Borscheid, Edward Cho, Houssam Osman, Rohan Jeyarajah. Methodist Richardson Medical Center
Introduction: Heller myotomy is the standard surgical treatment for achalasia. Although robotic surgery is increasingly utilized in general surgery, the literature provides few guidelines on the learning curve for adoption. There have been no publications addressing the robotic learning curve for Heller myotomy. We sought to determine the learning curve for robotic Heller myotomy.
Methods: This was a retrospective review of all laparoscopic (group A) and robotic (group B) Heller myotomies performed by a single surgeon at one of two tertiary care hospitals from August, 2012 to April, 2018. The main outcome measures included estimated blood loss, operative time, conversion to open, length of hospital stay, and presence of leak. We also looked at these outcome measures as cumulative robotic experience increased.
Results: In total, 68 patients underwent laparoscopic or robotic Heller myotomy within the stated date range. Group A consisted of 14 patients that had a laparoscopic approach and group B consisted of 54 patients that had a robotic approach. There was no statistically significant difference in operative time, conversion to open, leak, or length of stay when comparing the two groups. As cumulative robotic experience increased, there was no statistically significant difference in estimated blood loss, operative times, conversion to open, leak, or length of stay. There was a trend toward shorter operative times and decreased EBL as robotic experience increased.
Conclusions: When a surgeon has performed the necessary case volume to master the laparoscopic approach to Heller myotomy, there is no learning curve to incorporate the robotic approach.
| Group A (n=14) | Group B (n=54) | |
| median OR time | 92 | 93 |
| conversion to open | 0 | 0 |
| leak | 0 | 0 |
| median EBL | 30 | 40 |
| median LOS | 2 | 2 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95477
Program Number: P452
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster