Three-dimensional pressure imaging: a novel method for intraoperative manometry during laparoscopic esophagomyotomy for esophageal achalasia.

With the introduction of computerized manometry, the creation of the three-dimensional (3-D) pressure image with measurement of pressure vector volume (PVV) has become available to assess the pressure structure of the high-pressure zone (HPZ) of the distal esophagus. We have applied this technique to intraoperative manometry during laparoscopic surgery for esophageal achalasia (EA). A laparoscopic esophagomyotomy with anterior fundoplication was performed in a 12-year-old boy with EA. Computerized 3-D images were obtained by a stepwise pullback of a manometric assembly with eight radial side-holes to quantitate the PVV of the HPZ of the distal esophagus in each stage of the operation for EA. Virtual abolishment of the peak pressure image and a marked reduction in the PVV after esophagomyotomy suggested appropriate decompression of the HPZ. Intraoperative manometry using computerized 3-D pressure imaging with measurement of the PVV is thus useful to assess the HPZ during laparoscopic surgery for EA.