AB005. Initial experience in using a dual console robotic platform for training in minimally invasive Heller’s myotomy for achalasia

Background: Achalasia is a rare condition characterized by loss of myenteric cells in Auerbach’s plexus. Although there are a range of endoscopic options, laparoscopic Heller’s myotomy with anterior fundoplication is the gold standard intervention. The Da Vinci dual-console Xi offers a novel platform to approach this condition both as a minimally invasive procedure and as a training platform.

Methods: This study shows the first two robotic assisted Heller’s myotomies performed. The dual console platform was used with a consultant and senior surgical trainee operating simultaneously. Perioperative and intra-operative parameters were recorded.

Results: Two male patients underwent robotic assisted Heller’s myotomy, aged 38 and 42. Operative times were 100 and 115 min respectively. The Da Vinci Xi system facilitates hiatal dissection and allows careful and accurate oesophageal mobilisation. The dual console system facilitates training and allows simultaneous use of all three operating arms. Both patients underwent satisfactory myotomy and anterior Dor fundoplication. Post-operative contrast swallows showed satisfactory outcomes and no contrast leak. Patient lengths of stay were 4 and 5 days.

Conclusions: The dual console Da Vinci Xi system facilitates excellent and careful dissection at the hiatus. The dual console platform facilitates training and allows simultaneous operating to fully utilise all operating arms.

Keywords: Achalasia; Heller’s myotomy; dual console