Use of harmonic scalpel at laparoscopic cardiomyotomy. A new method.

The laparoscopic cardiomyotomy with anterior fundoplication (Heller-Dor procedure) is accepted for treatment of esophageal achalasia. The crucial point of the procedure is proper myotomy and avoid perforation of the esophagus. Hook cautery is widely accepted to dissect the oesophageal muscle. We'd like to demonstrate our experiences with a new device--Ultrasonically Activated Harmonic Scalpel-, witch was used at our operation for achalasia to make the cardiomyotomy. Between December 1993 and December 1996, 11 patients with esophageal achalasia underwent laparoscopic Heller's operation with Dor's antireflux procedures. In one patient we applied the Ultrasonically Activated Harmonic Scalpel (HS) to make the cardiomyotomy. The use of HS and results were evaluated. Application of the Harmonic Scalpel is effective for cardiomyotomy. It can be used more safe than electrocoagulation, because it cause less thermic lesion. It's easy to use at laparoscopic way. A perforation of the esophagus didn't occur. There was no intra-, or postoperative complications. After the operation the patient is free of complains. After our first operation, we have found, that Ultrasonically Activated Scalpel can be applied with safe and good results for the cardiomyotomy at laparoscopic operations for esophageal achalasia.