Robotic versus laparoscopic median arcuate ligament (MAL) release: a retrospective comparative study

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Surgical Technology

Background:

• Median arcuate ligament syndrome (MALS) is managed with laparoscopic median arcuate ligament division and celiac neurolysis.
• Previous studies confirm the safety and feasibility of laparoscopic approaches for MALS.

Purpose of the Study:

• To compare the clinical outcomes and safety of robotic median arcuate ligament release (RMALR) versus laparoscopic MAL release (LMALR).
• To evaluate the efficacy of each surgical approach in managing MALS symptoms and improving patient quality of life.

Main Methods:

• A retrospective analysis of 26 RMALR and 24 LMALR procedures performed by a single surgeon.
• Primary endpoint: postoperative reduction in celiac trunk expiratory peak systolic velocities (PSVs) via duplex ultrasonography.
• Secondary outcomes: MALS symptom improvement, operative time, length of stay, and assistant surgeon seniority.

Main Results:

• Both RMALR and LMALR effectively reduced postoperative PSVs.
• RMALR showed significantly greater improvement in chronic abdominal pain, postprandial pain, and nausea.
• RMALR procedures had longer operative times and involved more junior first assistants.

Conclusions:

• Both robotic and laparoscopic MAL release are safe and feasible for MALS management in experienced centers.
• RMALR demonstrated superior relief for specific MALS symptoms, despite longer operative times.
• Laparoscopic MAL release may be more efficient in terms of operative time and assistant experience.