Minimally invasive surgery for esophageal motility disorders

There has been a phenomenal expansion of the frontiers of minimally invasive surgery in the past decade. Surgery of the esophagus is no exception to this fact; it has been a hot seat for minimal access techniques, arguably outpacing interest in laparoscopic surgery of the biliary tract. Although the rapidly expanding role of antireflux surgery has encompassed much of this interest, motility disorders remain an important and growing clinical need. Since the introduction of laparoscopic cardiomyotomy for achalasia [1] in 1991, minimally invasive surgical treatments have been used to approach most if not all esophageal motility disorders, including diffuse esophageal spasm [2,3], nutcracker esophagus, hypertensive lower esophageal sphincter [4], and both epiphrenic and Zenker's diverticula [5-8]. Laparoscopic distal esophageal myotomy is slowly emerging as the most widely accepted primary option for the treatment of achalasia. Although a thoracoscopic approach for achalasia was widely used in the past, it has now been largely abandoned. Transoral endoscopic cricopharyngeal division for Zenker's diverticulum has evolved as the favored method in Europe [7] and is gaining acceptance in North America [6,9].