Laparoscopic Esophagomyotomy for Achalasia: How I Do It

The pathophysiology, diagnosis, and treatment options for achalasia are briefly discussed, followed by a description of the minimally invasive surgical approaches to this disease, as practiced by the authors. Laparoscopic myotomy is performed routinely at our institution in the lithotomy position under endoscopic control. The techniques for performing the myotomy, the use of fundoplication, and the adaptation of this approach to use the surgical robot are described. Laparoscopic esophagomyotomy has been highly effective, durable, safe, and widely accepted by patients. There is less data about the robotic approach, but increased degrees of freedom afforded by articulation in the instruments promises finer control and possibly lower perforation rates.