Treatment options for esophageal conditions vary, but one of the most effective long-term therapies is myotomy, which is a generic term for surgery in which a muscle is cut. In esophageal conditions, the surgeon typically cuts the muscle fibers in the lower esophageal sphincter, or LES, to correct the condition.
There are several ways to perform a myotomy:
Open Surgery
The surgery is performed by means of thoracotomy or incision. When used to treat achalasia, this is called a Heller myotomy.
Laparoscopic Surgery
The surgery is performed through tiny incisions in the abdomen, so it is minimally invasive. A thin, lighted tube called a laparoscope, and other surgical tools, are inserted through the incisions to allow the surgeon to work on the esophagus.
Robotic-Assisted Myotomy
In this version of the minimally invasive surgery, the surgeon guides robotic instruments inside the abdomen using a computer console. The surgeon’s natural hand movements are conveyed to the robotic instruments, which mimic the same movements that would be used if larger incisions (big enough for the surgeon’s hands) were used.
Boston Medical Center was the first center in New England to perform thoracic procedures—such as Heller myotomy—using robotics.
Peroral Endoscopic Myotomy (POEM)
In the POEM procedure, a flexible tube called an endoscope is inserted through the mouth and used to cut the muscles. It’s the least invasive type of myotomy, and doesn’t involve any incisions.