Robotic-assisted Median Arcuate Ligament Release: Phrenoesophageal Membrane Preserving Step-by-Step Technique and Early Outcomes

Median arcuate ligament syndrome (MALS) is a rare entity that presents with severe and life-limiting abdominal pain food fear. The robotic platform has recently emerged as tool for MALS release owing to enhanced visualization ergonomics. aim of this study was evaluate the feasibility results phrenoesophageal membrane preserving median (PEMP-MALS) treatment celiac artery compression syndrome. We retrospectively reviewed records patients who underwent between October 2019 2022 at our institution. Demographic information, symptoms, radiologic imaging details, postoperative complications, follow-up were analyzed. used measure centrality continuous variables. All surgeries performed using DaVinci Xi platform, an experienced vascular surgeon present entirety procedure. Eleven evaluated MALS. Ten female (91%) age 20 [17-33] years body mass index 22 [19.7-23.5] kg/m2. Preoperative symptoms included postprandial (100%), exertional (91%), weight loss (81%) (Table I). Celiac confirmed on duplex (median peak systolic velocity, 360 [335-418] cm/s) computed tomography angiography in 56% patients. Nine reported symptom relief preoperative ganglion block. Robotic successfull all 11 (100%) by PEMP technique. Estimated blood <100 mL, hospital stay 2 [2-3] days. One patient converted laparotomy due intraoperative bleeding. showed complete resolution II). improved symptomatically 6-month follow-up. persistently elevated velocities (peak velocity >200 no reoperated residual low-lying In experience, robot-assisted PEMP-MAL appears be safe associated short low risk complications. Three-dimensional magnified visualization, instrument stability, wristed ergonomics facilitate precise effective dissection critical structures. A co-surgeon’s presence during surgery timely conversion event bleeding.Table IDemographics variablesDemographics variablesValuesAge, [CI], years20 [17-33]BMI, kg/m222 [19.7-23.5]Sex, No. (%) Female10/11 (91) Male1/11 (9)Symptoms, Postprandial pain11/11 (100) Exertional pain10/11 Weight loss9/11 (81)Relief block, (%)9/11 (81)Preoperative PSV, cm/s360 [335-418]BMI, Body index; CI, confidence interval; velocity. Open table new tab Table IIResultsResultsValuesOperative time, minutes229 [110-140.3]Follow-up, months11 [2-19]Postoperative cm/s193 [175-202]Hospital stay, days2 [2-3]Complications, Conversion laparotomy1/11 (9) Incomplete release1/11 (9)Complete resolution9/11 (81)Improved pain1/11 (9)Persistent (9)CI, Confidence