8322GS Single Incision Laparoscopic Heller Myotomy and Anterior Fundoplication

TITLE: Single-Incision Laparoscopic Heller Myotomy and Anterior Fundoplication

Background: Single-incision laparoscopic surgery (SILS) continues the evolutionary arc from open to laparoscopic to minimal scar surgery, facilitating improved patient recovery and improved cosmesis. Promises of patient acceptance of SILS are high and will drive investment of resources to promptly develop safe and effective SILS procedures for clinical application.
Methods: This video demonstrates SILS Heller myotomy and anterior fundoplication with intraoperative endoscopy in the treatment of achalasia. First, esophagogastroscopy documents the presence of a dilated distal esophagus and a snug gastroesophageal junction. Then, a single 10-mm incision is utilized to place three 5-mm trocars at the umbilicus: one trocar is utilized for liver retraction, another for an articulating laparoscope, and the third as an operating port. Sutures are placed in the fundus and along the lesser curvature to facilitate exposure. Dissection frees the esophagus from the hiatus laterally and along its ventral surface. Longitudinal muscle fibers are divided with hook electrocautery to provide exposure for division of transverse muscle fibers. Repeat esophagogastroscopy is undertaken to document an adequate myotomy: the scope must pass easily through the gastroesophageal junction, the myotomy must be visualized to cross the squamocolumnar junction (ie, the z-line), and no esophagotomy/gastrotomy or submucosal burn should be noted. Anterior fundoplication, covering most of the myotomized esophagus, is constructed to provide optimal control of postoperative gastroesophageal reflux.
Conclusion: Single-incision laparoscopic Heller myotomy and anterior fundoplication will be embraced by patients, and laparoscopic surgeons will need to meet patient demands.

Abs# 8322
Authors: Sharona B. Ross, MD, Connor Morton, BS, Desiree Villadolid, MPH, Donovan Tapper, MD, Alexander Rosemurgy, MD

Category:

Science & Technology

Tags:

• 'society
• of
• laparoendoscopic
• surgeons'
• SocietyLapSurgeons
• SLSGeneralSurgery
• SLSEducation
• SLSEE08
• SLSMyotomy
• SLSSILS
• SLSFundoplication
• laparoscopy
• laparoscopic
• SLS
• 'single
• incision'
• 'heller
• myotomy'
• 'laparoscopic
• heller
• 'anterior
• fundoplication'

[furbss]

Good for med students to watch before going into the OR :-) Good description of what's going on.