Achalasia is a motility disease of the esophagus, characterized by the absence of peristalsis in the esophageal body and incomplete relaxation of the lower esophageal sphincter, which may be hypertensive. Therefore, the aim of the therapy is to improve esophageal emptying by eliminating the outflow resistance caused by the lower esophageal sphincter. Since the advent of laparoscopy, endoscopic treatment modalities have been replaced by laparoscopic Heller myotomy as the procedure of choice to treat achalasia. This radical change replicated the excellent results of open surgery with relief of dysphagia in 85–95 % of the patients but with shorter hospital stay, faster recovery and minimal postoperative discomfort. However, laparoscopic myotomy poses technical challenges for the surgeons and requires an extensive learning curve, which contributes with the significant number of intraoperative mucosal perforations. Robotic-assisted Heller myotomy sheds new light on minimally invasive treatments by dealing with these technical challenges and improving outcomes.
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