Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique Kenneth A Kesler, MD, Stacey E Tarvin,

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Presentation transcript:

Thoracoscopy-assisted Heller myotomy for the treatment of achalasia: results of a minimally invasive technique Kenneth A Kesler, MD, Stacey E Tarvin, MS, Jo Ann Brooks, DNS, Karen M Rieger, MD, Glen A Lehman, MD, John W Brown, MD The Annals of Thoracic Surgery Volume 77, Issue 2, Pages 385-392 (February 2004) DOI: 10.1016/j.athoracsur.2003.06.018

Fig 1 Planned incision based on estimated level of diaphragm dome and position of primary surgeon with first and second assistants. (Thin dashed line = estimated level of diaphragm; thick dashed line = incision.) The Annals of Thoracic Surgery 2004 77, 385-392DOI: (10.1016/j.athoracsur.2003.06.018)

Fig 2 (A) Initial identification of the submucosal layer by judicious dissection with an extended electrocautery unit. (B) Establishing a submucosal plane toward the inferior pulmonary vein with a right-angle clamp before myotomy. The forceps are used to stabilize and retract the esophagus downward. The Annals of Thoracic Surgery 2004 77, 385-392DOI: (10.1016/j.athoracsur.2003.06.018)

Fig 3 (A) Upward countertraction by the surgeon and first assistant facilitates right angle dissection as the myotomy is carried inferiorly onto the cardia. (B) Any remaining circular muscle fibers around the gastroesophageal junction and cardia are judiciously divided with an extended electrocautery tip. The Annals of Thoracic Surgery 2004 77, 385-392DOI: (10.1016/j.athoracsur.2003.06.018)