Robot-assisted Heller myotomy in the treatment of achalasia in children

封面


如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

BACKGROUND: Esophageal achalasia in children is a rare disease. Heller myotomy combined with Dor fundoplication remains the treatment of choice for this disease. Surgical interventions include open, laparoscopic and robotic approaches. This article describes the first experience of Heller robot-assisted myotome in a child. It also presents a literature review on this topic.

CLINICAL CASE DESCRIPTION: The authors present retrospective data of a 10-year-old adolescent boy who was operated on for esophageal achalasia with the robot-assisted approach. The patient was admitted to the surgical department of Irkutsk State Regional Children's Clinical Hospital in satisfactory condition with complaints of dysphagia, frequent regurgitation after meals, and delayed weight gain. The diagnosis of cardia achalasia was put after contrast examination of the esophagus and after endoscopic examination of the upper gastrointestinal tract and after esophageal manometry. Heller robot-assisted myotomy was performed with surgical robot Versius (manufactured by CMR, UK). Patient's weight was 30 kg. His age was 10 years. This disease lasted for 3 years. Robot-assisted Heller myotomy was done in a minimally invasive manner without conversion to an open surgery. Total myotomy length was 7 cm; duration of surgical intervention — 125 minutes; duration of patient's stay in the hospital — 4 days; duration of follow-up — 4 months. In the late follow-up, no significant complications, like symptom recurrence or reflux, were seen.

CONCLUSION: Robotic-assisted Heller myotomy for esophageal achalasia in children is safe and effective technique. It is also good alternative to open and laparoscopic surgeries.

全文:

受限制的访问

作者简介

Yury Kozlov

Children's Regional Clinical Hospital; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X
SPIN 代码: 3682-0832

MD, Cand. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk; Irkutsk; Irkutsk

Simon Poloyan

Children's Regional Clinical Hospital; Irkutsk State Medical University

Email: simonpoloyan@ya.ru
ORCID iD: 0000-0001-7042-6646

MD

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk; Irkutsk

Eduard Sapukhin

Children's Regional Clinical Hospital

Email: sapukhin@yandex.ru
ORCID iD: 0000-0001-5470-7384

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk

Alexey Strashinsky

Children's Regional Clinical Hospital

Email: strashinskiia.s@gmail.ru
ORCID iD: 0000-0002-1911-4468

MD

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk

Marina Makarochkina

Children's Regional Clinical Hospital

Email: m.makarochkina@gmail.com
ORCID iD: 0000-0001-8295-6687
SPIN 代码: 4600-4071

MD

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk

Andrey Marchuk

Children's Regional Clinical Hospital

编辑信件的主要联系方式.
Email: maa-ped20@yandex.ru
ORCID iD: 0000-0001-9767-0454

MD

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk

Alexander Rozhanski

Irkutsk State Medical University

Email: alexanderozhanski@mail.ru
ORCID iD: 0000-0001-7922-7600
SPIN 代码: 4012-7120

MD

俄罗斯联邦, Irkutsk

Anton Byrgazov

Children's Regional Clinical Hospital

Email: byrgazov.ant-doc38@yandex.ru
ORCID iD: 0000-0002-9195-5480

MD

俄罗斯联邦, 4 Gagarina boulevard, 664022 Irkutsk

Sergey Muravev

Irkutsk State Medical University

Email: muravev1999sergey@mail.ru
ORCID iD: 0000-0003-4731-7526

MD

俄罗斯联邦, Irkutsk

Artem Narkevich

South-Ural State Medical University; Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

Email: narkevichart@gmail.com
ORCID iD: 0000-0002-1489-5058

MD

俄罗斯联邦, Chelyabinsk; Krasnoyarsk

参考

  1. Nicolas A, Aumar M, Tran LC, et al. Comparison of endoscopic dilatation and heller's myotomy for treating esophageal achalasia in children: A multicenter study. J Pediatr. 2022;(251):134–139.e2. doi: 10.1016/j.jpeds.2022.07.010
  2. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: A systematic review and meta-analysis. Ann Surg. 2009;249(1):45–57. doi: 10.1097/SLA.0b013e31818e43ab
  3. Esposito C, Mendoza-Sagaon M, Roblot-Maigret B, et al. Complications of laparoscopic treatment of esophageal achalasia in children. J Pediatr Surg. 2000;35(5):680–683. doi: 10.1053/jpsu.2000.5942
  4. Zhang LP, Chang R, Matthews BD, et al. Incidence, mechanisms, and outcomes of esophageal and gastric perforation during laparoscopic foregut surgery: A retrospective review of 1,223 foregut cases. Surg Endosc. 2014;28(1):85–90. doi: 10.1007/s00464-013-3167-1
  5. Chaer RA, Jacobsen G, Elli F, et al. Robotic-assisted laparoscopic pediatric Heller's cardiomyotomy: Initial case report. J Laparoendosc Adv Surg Tech A. 2004;14(5):270–273. doi: 10.1089/lap.2004.14.270
  6. Lorincz A, Langenburg S, Klein MD. Robotics and the pediatric surgeon. Curr Opin Pediatr. 2003;15(3):262–266. doi: 10.1097/00008480-200306000-00006
  7. Knight CG, Lorincz A, Gidell KM, et al. Computer-assisted robot-enhanced laparoscopic fundoplication in children. J Pediatr Surg. 2004;39(6):864–866; discussion 864–866. doi: 10.1016/j.jpedsurg.2004.02.022
  8. Klein MD, Langenburg SE, Kabeer M, et al. Pediatric robotic surgery: Lessons from a clinical experience. J Laparoendosc Adv Surg Tech A. 2007;17(2):265–271. doi: 10.1089/lap.2006.0034
  9. Najmaldin A, Antao B. Early experience of tele-robotic surgery in children. Int J Med Robot. 2007;3(3):199–202. doi: 10.1002/rcs.150
  10. Meehan JJ, Sandler A. Pediatric robotic surgery: A single-institutional review of the first 100 consecutive cases. Surg Endosc. 2008;22(1):177–182. EDN: JAOVRH doi: 10.1007/s00464-007-9418-2
  11. Camps JI. The use of robotics in pediatric surgery: My initial experience. Pediatr Surg Int. 2011;27(9):991–996. doi: 10.1007/s00383-011-2901-9
  12. Ballouhey Q, Dib N, Binet A, et al. How robotic-assisted surgery can decrease the risk of mucosal tear during Heller myotomy procedure? J Robot Surg. 2017;11(2):255–258. doi: 10.1007/s11701-016-0658-9
  13. Altokhais T, Mandora H, Al-Qahtani A, Al-Bassam A. Robot-assisted Heller's myotomy for achalasia in children. Comput Assist Surg (Abingdon). 2016;21(1):127–131. doi: 10.1080/24699322.2016.1217352
  14. Ferrero PA, Blanc T, Binet A, et al. The potential and the limitations of esophageal robotic surgery in children. Eur J Pediatr Surg. 2022;32(2):170–176. doi: 10.1055/s-0040-1721770
  15. Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: Late results of a prospective follow up investigation. Gut. 2004;53(5):629–633. doi: 10.1136/gut.2003.029298
  16. Franklin AL, Petrosyan M, Kane TD. Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management. World J Gastrointest Endosc. 2014;6(4):105–111. doi: 10.4253/wjge.v6.i4.105
  17. Sharp NE, Peter SD. Treatment of idiopathic achalasia in the pediatric population: A systematic review. Eur J Pediatr Surg. 2016;26(2):143–149. doi: 10.1055/s-0035-1544174
  18. Pachl MJ, Rex D, Decoppi P, et al. Paediatric laparoscopic Heller's cardiomyotomy: A single centre series. J Pediatr Surg. 2014;49(2):289–292; discussion 292. doi: 10.1016/j.jpedsurg.2013.11.042
  19. Paidas C, Cowgill SM, Boyle R, et al. Laparoscopic Heller myotomy with anterior fundoplication ameliorates symptoms of achalasia in pediatric patients. J Am Coll Surg. 2007;204(5):977–983; discussion 983–986. doi: 10.1016/j.jamcollsurg.2006.12.046
  20. Hughes MJ, Chowdhry MF, Walker WS. Can thoracoscopic Heller's myotomy give equivalent results to the more usual laparoscopic Heller's myotomy in the treatment of achalasia? Interact Cardiovasc Thorac Surg. 2011;13(1):77–81. doi: 10.1510/icvts.2011.268169
  21. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–271. doi: 10.1055/s-0029-1244080
  22. Maselli R, Inoue H, Misawa M, et al. Peroral endoscopic myotomy (POEM) in a 3-year-old girl with severe growth retardation, achalasia, and Down syndrome. Endoscopy. 2012;44 (Suppl. 2 UCTN):E285-7. doi: 10.1055/s-0032-1309924
  23. Galvani C, Gorodner MV, Moser F, et al. Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc. 2006;20(7):1105–1112. EDN: PSMQPU doi: 10.1007/s00464-005-0272-9
  24. Caldaro T, Familiari P, Romeo EF, et al. Treatment of esophageal achalasia in children: Today and tomorrow. J Pediatr Surg. 2015;50(5):726–730. doi: 10.1016/j.jpedsurg.2015.02.047
  25. Shaligram A, Unnirevi J, Simorov A, et al. How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia. Surg Endosc. 2012;26(4):1047–1050. EDN: DKKQSY doi: 10.1007/s00464-011-1994-5
  26. Midya S, Ghosh D, Mahmalat MW. Fundoplication in laparoscopic Heller's cardiomyotomy for achalasia. Cochrane Database Syst Rev. 2022;12(12):CD013386. doi: 10.1002/14651858.CD013386.pub2
  27. Pandian TK, Naik ND, Fahy AS, et al. Laparoscopic esophagomyotomy for achalasia in children: A review. World J Gastrointest Endosc. 2016;8(2):56–66. doi: 10.4253/wjge.v8.i2.56
  28. Afaneh C, Finnerty B, Abelson JS, Zarnegar R. Robotic-assisted Heller myotomy: A modern technique and review of outcomes. J Robot Surg. 2015;9(2):101–108. doi: 10.1007/s11701-015-0506-3

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Esophagography of the patient with esophageal achalasia.

下载 (97KB)
索引源数据
3. Fig. 2. Heller robot-assisted myotomy: the stage of longitudinal dissection of muscular layer of the esophagus.

下载 (149KB)
索引源数据
4. Fig. 3. Heller robot-assisted myotomy: Dor fundoplication stage (fixation of the lateral edge of the cuff).

下载 (116KB)
索引源数据
5. Fig. 4. Heller robot-assisted myotomy: Dor fundoplication stage (fixation of the medial edge of the cuff).

下载 (100KB)
索引源数据

版权所有 © Kozlov Y.A., Poloyan S.S., Sapukhin E.V., Strashinsky A.S., Makarochkina M.V., Марчук А.А., Rozhanski A.P., Byrgazov A.A., Muravev S.A., Narkevich A.N., 2024

##common.cookie##