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Gastrointestinal Disorders
Volume 8
Issue 1
10.3390/gidisord8010005
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Review

Robotic Heller–Dor Myotomy for Esophageal Achalasia in the Elderly: Rationale, Evidence, and Future Directions in Geriatric Minimally Invasive Surgery

by
Agostino Fernicola
1,*,
Murtaja Satea
2,
Fahim Kanani
3,
Federico Maria Mongardini
4,
Jesus Enrique Guarecuco Castillo
5,
Alfonso Santangelo
6,
Felice Crocetto
7,
Armando Calogero
1,
José Maria Zepeda Torres
8,
Aniello Zoretti
1,
Luigi Ricciardelli
9,
Michele Santangelo
1 and
Salvatore Tolone
4
1
Unit of Emergency Surgery, Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
2
Department of Surgery, College of Medicine, University of Warith Al-Anbiyaa, Karbala 56001, Iraq
3
Department of Abdominal Organ Transplantation, Rabin Medical Center Beilinson Campus, Petah Tikva 49100, Israel
4
Department of General, Mininvasive, Oncologic and Obesity Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
5
Department of Surgery, Larkin Community Hospital, South Miami Campus, South Miami, FL 33143, USA
6
Unit of Urology, Division of Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
7
Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
8
Department of Plastic Surgery, Unidad Médica de Alta Especialidad (UMAE) de Traumatologia, Ortopedia y Rehabilitacion “Dr, Victorio de la Fuente Narvàez”, Instituto Mexicano del Seguro Social, Mexico City 07760, Mexico
9
Unit of Emergency Surgery, Dei Colli Hospital, CTO Hospital, 80131 Naples, Italy
*
Author to whom correspondence should be addressed.
Gastrointest. Disord. 2026, 8(1), 5; https://doi.org/10.3390/gidisord8010005
Submission received: 6 December 2025 / Revised: 27 December 2025 / Accepted: 29 December 2025 / Published: 2 January 2026
(This article belongs to the Special Issue GastrointestinaI & Bariatric Surgery)
Versions Notes

Abstract

Background: Esophageal achalasia increasingly affects elderly patients, in whom frailty and comorbidity complicate management and heighten procedural risk. Minimally invasive Heller–Dor myotomy remains the reference surgical treatment, while the advent of robotics has renewed interest in its potential advantages. Whether these refinements translate into meaningful benefits for older adults remains unclear. This gap is clinically significant given the distinct physiological vulnerabilities of older adults. Methods: A narrative review of the literature was conducted to examine current evidence on robotic Heller–Dor myotomy for achalasia, with specific focus on its applicability in elderly and frail patients. Comparative studies between robotic and laparoscopic approaches were analyzed and integrated with available data on achalasia management in older individuals. Results: Robotic Heller–Dor myotomy demonstrates equivalent efficacy to laparoscopic surgery, with reduced mucosal perforation rates, improved ergonomics, and comparable operative times once the learning curve is achieved. However, no published series has specifically analyzed outcomes in geriatric cohorts. Available evidence from laparoscopic studies confirms that surgery remains safe and effective in geriatric patients, suggesting that the precision of robotics could potentially further enhance safety and recovery in this subgroup. Conclusions: Robotic Heller–Dor myotomy represents a promising evolution of minimally invasive therapy for achalasia, potentially aligning technological refinements with the physiological needs of older adults. Prospective studies incorporating frailty assessment, patient-centered outcomes, and cost analyses are required to determine its true value and guide evidence-based use in the aging population.
Keywords: robotic Heller–Dor myotomy; esophageal achalasia; geriatric surgery; frailty; minimally invasive esophageal surgery; functional outcomes robotic Heller–Dor myotomy; esophageal achalasia; geriatric surgery; frailty; minimally invasive esophageal surgery; functional outcomes

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MDPI and ACS Style

Fernicola, A.; Satea, M.; Kanani, F.; Mongardini, F.M.; Castillo, J.E.G.; Santangelo, A.; Crocetto, F.; Calogero, A.; Zepeda Torres, J.M.; Zoretti, A.; et al. Robotic Heller–Dor Myotomy for Esophageal Achalasia in the Elderly: Rationale, Evidence, and Future Directions in Geriatric Minimally Invasive Surgery. Gastrointest. Disord. 2026, 8, 5. https://doi.org/10.3390/gidisord8010005

AMA Style

Fernicola A, Satea M, Kanani F, Mongardini FM, Castillo JEG, Santangelo A, Crocetto F, Calogero A, Zepeda Torres JM, Zoretti A, et al. Robotic Heller–Dor Myotomy for Esophageal Achalasia in the Elderly: Rationale, Evidence, and Future Directions in Geriatric Minimally Invasive Surgery. Gastrointestinal Disorders. 2026; 8(1):5. https://doi.org/10.3390/gidisord8010005

Chicago/Turabian Style

Fernicola, Agostino, Murtaja Satea, Fahim Kanani, Federico Maria Mongardini, Jesus Enrique Guarecuco Castillo, Alfonso Santangelo, Felice Crocetto, Armando Calogero, José Maria Zepeda Torres, Aniello Zoretti, and et al. 2026. "Robotic Heller–Dor Myotomy for Esophageal Achalasia in the Elderly: Rationale, Evidence, and Future Directions in Geriatric Minimally Invasive Surgery" Gastrointestinal Disorders 8, no. 1: 5. https://doi.org/10.3390/gidisord8010005

APA Style

Fernicola, A., Satea, M., Kanani, F., Mongardini, F. M., Castillo, J. E. G., Santangelo, A., Crocetto, F., Calogero, A., Zepeda Torres, J. M., Zoretti, A., Ricciardelli, L., Santangelo, M., & Tolone, S. (2026). Robotic Heller–Dor Myotomy for Esophageal Achalasia in the Elderly: Rationale, Evidence, and Future Directions in Geriatric Minimally Invasive Surgery. Gastrointestinal Disorders, 8(1), 5. https://doi.org/10.3390/gidisord8010005

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