Robotic Surgery for Median Arcuate Ligament Syndrome

Fernstrum, Colton; Pryor, Michael; Wright, G. Paul; Wolf, Andrea

doi:10.4293/jsls.2020.00014

Cited by 29 publications

(30 citation statements)

References 27 publications

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“…MALS, also known as Dunbar syndrome or celiac artery compression syndrome, typically presents as a vague constellation of abdominal symptoms [5][6][7]. In a study of 36 patients with MALS, 94% reported abdominal pain, 80% reported postprandial pain, 56% reported nausea and vomiting, 50% experienced weight loss, and only 8% stated they had abdominal pain triggered by exercise [8].…”

Section: Discussionmentioning

confidence: 99%

“…The mainstay treatment for MALS is surgical decompression by dividing the fibers compressing the celiac trunk. Open and laparoscopic techniques of median arcuate ligament release have been considered the standard operation, but new robotic approaches have gained popularity in recent years [ 6 ]. Some alternative procedures will also remove the celiac plexus [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…This lack of clinical success is generally thought to be related to the lack of criteria available for identifying surgical candidates with the best likelihood of symptom resolution. One study suggested that persistent symptoms should be investigated for a co-morbidity or unresolved stenosis of the artery [ 6 ]. An initial surgery that fails to resolve the patient's symptoms may suggest the patient is a candidate for further interventions such as endovascular techniques or vascular bypass [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

Scharf¹,

Thomas²,

Sundaram³

et al. 2021

Cureus

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Median arcuate ligament syndrome refers to anatomical compression of the celiac artery and/or ganglion by fibrous attachments of the median arcuate ligament. It typically presents as a vague constellation of abdominal symptoms that are often initially attributed to various other gastrointestinal pathologies; thus, it can be very difficult to diagnose. We present a case of median arcuate ligament syndrome in a 68-year-old woman, whose diagnosis and treatment were delayed by many years as her symptoms were taught to be the result of functional abdominal pain syndrome, ultimately corrected by laparoscopic decompression of the celiac axis. This case demonstrates that surgical decompression of the celiac axis is an effective treatment for median arcuate ligament syndrome and the importance of continuing to reassess the clinical picture of patients labeled with functional abdominal pain syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

Scharf¹,

Thomas²,

Sundaram³

et al. 2021

Cureus

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“…8,9 Robotic approaches to median arcuate ligament release offer enhanced 3D visualisation, improved stability and ergonomics, and increased ability to operate in more confined spaces, and the results have been promising with comparable short and intermediate term outcomes to laparoscopic approaches. 10,11 The short-term results of laparoscopic versus open, as well as ligament release alone versus combined with coeliac artery manipulation, are comparable, but there is again insufficient evidence to determine assess recurrence or restenosis. 7 This is further compounded by the fact that the pathophysiology behind MALS remains poorly understood, and so the potential placebo effect remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome and a laparoscopic coeliac trunk first approach: a literature review and a proposed algorithm

Sarkar

Jaber

2021

Int Surg J

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Median arcuate ligament syndrome (MALS) is a rare condition where chronic recurrent abdominal pain is related to the compressive effects of the median arcuate ligament on the coeliac artery. The mechanism behind this phenomenon is incompletely understood but thought to be both ischemic and neuropathic in nature. As a result, the management of this condition remains controversial. Furthermore, while there have been a variety of options both radiological and interventional described for the investigation of MALS, there has yet to be a consensus in how patients exhibiting symptoms should be assessed and worked up. In this article, we described a laparoscopic coeliac trunk first approach in a young female patient and following review of the literature, propose an algorithm that can be used in the assessment and management of suspected MALS.

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“…Furthermore, 4% of patients had no symptom resolution and 24% had symptom recurrence after an initial period of symptom resolution. The authors concluded that robotic MALR is a safe option for treatment of MALS with high-response rates [65].…”

Section: Median Arcuate Ligament Releasementioning

confidence: 97%

Robotic Surgery for the Thoracic and Vascular Surgeon

Berzenji¹,

Yogeswaran²,

Lauwers³

et al. 2021

Latest Developments in Medical Robotics Systems

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In the last two decades, robotic-assisted approaches have gained popularity as alternatives to conventional open and minimal-invasive surgery (MIS). The robotic approach combines the concepts of the traditional MIS with the latest technological advancements, enabling the surgeon to control the instrumentation using a robotic device connected to a remote console. With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception and hand-eye coordination. Since its introduction, numerous robotic-assisted procedures have been developed and tested across nearly all surgical fields. Data from previous studies have shown that a great majority of these techniques are feasible and have favourable treatment outcomes. In the field of thoracic and vascular surgery, two disciplines often combined in Belgium, robotic approaches have been implemented in the treatment of a wide array of disorders including lung cancer, mediastinal tumours, thoracic outlet syndrome, diaphragmatic paralysis, sympathectomy, aortobifemoral bypass surgery and division of the arcuate ligament for median arcuate ligament syndrome (MALS). Despite this increasing popularity, there are still a number of controversies regarding robotic surgery. There are only limited data on the cost-effectiveness of robotic surgery and its objective proven benefit over conventional MIS. In this review, we summarise the latest data on robotic approaches for the most relevant thoracic and vascular disorders.

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Robotic Surgery for Median Arcuate Ligament Syndrome

Cited by 29 publications

References 27 publications

Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

Median arcuate ligament syndrome and a laparoscopic coeliac trunk first approach: a literature review and a proposed algorithm

Robotic Surgery for the Thoracic and Vascular Surgeon

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