Robotic-assisted approach to Median Arcuate Ligament Syndrome with left gastric artery originating directly from the aorta. Report of a case and review of the current mini-invasive treatment modalities

Int J Med Robot. 2018 Aug;14(4):e1919. doi: 10.1002/rcs.1919. Epub 2018 May 9.

Abstract

Background: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition.

Methods: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible.

Results: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%).

Conclusions: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity.

Keywords: Dunbar syndrome; celiac artery compression syndrome; median arcuate ligament syndrome; minimally invasive surgery; robotic-assisted.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aorta / diagnostic imaging
  • Celiac Artery / diagnostic imaging
  • Celiac Artery / surgery
  • Decompression, Surgical / methods*
  • Female
  • Ganglia, Sympathetic / surgery
  • Humans
  • Imaging, Three-Dimensional
  • Laparoscopy / methods
  • Median Arcuate Ligament Syndrome / diagnostic imaging
  • Median Arcuate Ligament Syndrome / surgery*
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Robotic Surgical Procedures / methods*
  • Tomography, X-Ray Computed
  • Treatment Outcome