Robotic Repair of Median Arcuate Ligament Syndrome

Background: Median arcuate ligament syndrome (MALS) is an uncommon, nevertheless significant, cause of abdominal pain. There have been reports of laparoscopic dissection of the median arcuate ligament providing relief of symptoms. Robotic-assisted laparoscopy for treatment has recently been described as well. Robotic-assisted laparoscopy provides for a precise dissection around the aorta, its branches, and nerves. Here we provide a case of a MALS, description of the operative technique, and postoperative outcome.



Methods:
 A robotic-assisted laparoscopic dissection of the median arcuate ligament was performed in a patient by using the da Vinci Si Surgical System. One 12-mm supraumbilical port is placed for the camera. A 5-mm port is placed in the right flank for the liver retractor. Three 8-mm robotic ports are then placed in the left flank, right and left subcostal. A combination of Harmonic scalpel and permanent hook cautery were used to divide the tissues and the offending fibrous bands.



Results:
The patient underwent a successful operation with an uncomplicated postoperative course. She had subjective relief of symptoms. There was notable improvement in celiac artery velocity compared to preoperative mesenteric duplex.



Conclusion:
Robotic-assisted laparoscopy is gaining acceptance in many general surgical operations. The robotic approach to surgical resolution of median arcuate ligament syndrome is safe and has met with excellent outcomes, subjective and objective alike.

Robotic Repair of Median Arcuate Ligament Syndrome

Abbas Abbas, MD, Saleh A. Massasati, MD, Hernan Bazan, MD, Jay Luke, MD, 

Mathew Gaudet, MD

Ochsner Medical Center, New Orleans, Louisiana, USA (Drs. Abbas, Bazan, Luke, Gaudet).
Tulane University School of Medicine, New Orleans, Louisiana, USA (Dr. Massasati).