Achalasia is a rare disease (occurring 0.4 to 0.6 times per 100,000 people) in which the lower esophageal sphincter does not relax properly and patients experience symptoms including difficulty swallowing and regurgitating food. Achalasia affects men and women equally and is most commonly seen in those in their thirties to forties. It is characterized by an abnormal relaxation of the lower esophagus as well as an absence of progressive peristalsis (the smooth muscles contractions that propel food through the body of the esophagus).

The natural history of this disease is one in which there is a slow and gradual difficulty in swallowing or an inability to swallow. The esophagus continues to dialate and there is a progressive widening of the esophagus which results in peristalsis in the lower area of the esophagus and increased dysfunction. Soon, the esophagus transforms from a tube that carries food to the stomach to a reservoir with areas of the lower esophagus pouching outward. Once this happens, patients experience complications from repeated aspiration and pulmonary infection, airway obstruction, and may even develop squamous cell carcinoma.

Robotic Myotomy
As the natural history of this disease is one of increasing symptoms and complications, the goal of surgery is to provide relief from the esophageal obstruction as soon as the diagnosis of achalasia has been confirmed. The preferred surgical approach is a Robotic transthoracic esophageal myotomy without an anti-reflux procedure.

For 16 patients (7 men, 9 women) who underwent a robotic assisted thoracoscopic esophageal myotomy for achalasia, without an antireflux procedure, the following outcomes were reported.

• Median hospitalization was four days.
• Postoperative esophagograms revealed excellent emptying into the stomach with no evidence of mucosal outpouching in all patients.
• All patients reported a subjective improvement in dysphagia.
• There were no mucosal injuries or conversion to a thoracotomy.
• Six of the 16 (37%) patients reported occasional mild reflux. Three patients (19%) required nonprescription antacids in order to resolve their reflux symptoms.