# 30-day outcomes of robotic versus laparoscopic Heller myotomy

## TL;DR

This study compares robotic and laparoscopic Heller myotomies for achalasia, finding similar short-term outcomes but higher morbidity and longer surgery times with the robotic approach.

## Contribution

The study provides a prospective comparison of robotic versus laparoscopic Heller myotomy outcomes using a national database and matching techniques.

## Key findings

- RAHM had higher morbidity (7.5% vs. 1.5%) and longer operative times compared to LHM.
- No mortalities were observed in either group.
- Readmission, reoperation rates, and length of stay were similar between the two groups.

## Abstract

Minimally invasive Heller myotomy has become the standard of care to treat patients with esophageal achalasia with improved morbidity and mortality compared to its open counterpart; however few studies have prospectively compared Robotic Heller myotomy (RAHM) to laparoscopic Heller myotomy (LHM).

The 2022 ACS-NSQIP database was queried to identify adults with achalasia who underwent RAHM versus LHM. Patients in the RAHM group were matched using Coarsened Exact Matching with the LHM group on their preoperative characteristics. Chi-square and Fisher exact tests were used for categorical analysis, and Student’s t-test was used for continuous data analysis. 30-day outcomes, including mortality, morbidity, operative time, length of hospital stay along with reoperation and readmission rates were compared between the two groups in both aggregate and matched cohorts.

In the aggregate cohort, patients in the RAHM were older (55.21 ± 16.28 vs. 49.71 ± 12.19, p = 0.007) and had a higher percentage of male patients (66.3% vs.49.5%, p = 0.011), but otherwise there were no statistically significant differences in co-morbidities between the two groups. In the matched cohort, there were no statistically significant differences in the preoperative characteristics between the two groups. There were no mortalities in the cohorts. In the aggregate cohort, RAHM was associated with higher morbidity (7.5% vs. 1.5%, p = 0.009) and longer operative times (166.65 ± 67.33 vs. 124.06 ± 52.61, p < 0.001). Similar findings were confirmed in the matched cohort. Overall surgical site infection (SSI), reintubation, deep vein thrombosis (DVT), and myocardial infarction (MI) were also higher in the RAHM group, but it did not reach statistical significance. There was no difference in readmission and reoperation rates, or length of stay between the two groups.

In this study, RAHM had similar short-term outcomes compared to LHM, but may be associated with higher overall morbidity and longer operative times.