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Published on: December 4, 2023
Robotic-assisted laparoscopic median arcuate ligament release: 7-year experience from a single tertiary care center
Usah Khrucharoen1,2, Yen-Yi Juo1,3,2, Yas Sanaiha1,2
1Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, BOX 956904, 72-239 CHS, Los Angeles, CA, 90095, USA.
Background:
Despite previous reports of robotic-assisted laparoscopic release for median arcuate ligament syndrome (MALS), the safety and efficacy profile of this approach has been difficult to establish due to the rarity of this diagnostic entity. We aim to present our experience from a tertiary minimally invasive surgery referral center.
Methods:
A case series was performed whereby all patients who underwent robotic-assisted MAL release from July 2010 to July 2017 at our institution were included. Diagnosis of MALS was made based on consideration of symptom presentation, celiac artery duplex ultrasound, and corresponding findings on Computed Tomography (CT) or Magnetic Resonance Angiography (MRA). Outcomes up until the most recent clinic follow-up were reviewed.
Results:
A total of 13 patients underwent robotic-assisted MAL release. Patients' age ranged from 16 to 71 years (mean 38 years) and consisted primarily of females (76.9%). Most common presenting symptoms included postprandial pain (76.9%), weight loss (76.9%), nausea and vomiting (76.9%). Mean symptom duration was 3 years (range 1-10 years). No intraoperative complications. None required conversion to open surgery. One case required a conversion back to laparoscopy due to anatomical complexity. The mean operative time for successfully completed robotic cases was 94.6 min (range 52-120 min), and for all cases including converted case was 103.5 min (52-210 min). Mean follow-up duration was 19.7 months (range 1-77 months). During subsequent follow-up, a 30-day readmission rate of 23.1% was observed. All but one of the patients experienced prompt symptom improvement. Four patients had symptom recurrence during follow-up.
Conclusions:
Our experience demonstrates that the robotic-assisted approach to MAL release may be safe and efficacious in selected patients. Prospective comparative studies are required to further evaluate its outcomes against conventional laparoscopic approach, the current gold standard.
Insights
Robotic-assisted median arcuate ligament release (MALS) shows promise for safety and efficacy in selected patients. Further comparative studies are needed to confirm its benefits against traditional laparoscopic methods.
Area of Science:
- Minimally Invasive Surgery
- Surgical Robotics
- Gastroenterology
Background:
- Median arcuate ligament syndrome (MALS) is rare, making safety and efficacy of robotic-assisted laparoscopic release challenging to assess.
- This study presents experience from a tertiary referral center specializing in minimally invasive surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of robotic-assisted median arcuate ligament release.
- To share outcomes from a tertiary minimally invasive surgery referral center.
Main Methods:
- A case series included 13 patients undergoing robotic-assisted MAL release between July 2010 and July 2017.
- MALS diagnosis was based on symptoms, celiac artery duplex ultrasound, and CT/MRA.
- Outcomes were reviewed up to the most recent clinic follow-up.
Main Results:
- 13 patients (76.9% female, mean age 38) underwent the procedure with common symptoms including postprandial pain, weight loss, and nausea.
- No intraoperative complications occurred; one conversion to laparoscopy was needed due to complexity.
- Mean follow-up was 19.7 months, with prompt symptom improvement in most patients, though 30-day readmission was 23.1% and 4 patients experienced recurrence.
Conclusions:
- Robotic-assisted MAL release appears safe and effective in select MALS patients.
- Prospective comparative studies are necessary to compare outcomes with conventional laparoscopic approaches.
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