Robotic-assisted median arcuate ligament release

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Presentation transcript:

Robotic-assisted median arcuate ligament release Daniel Relles, MD, Neil Moudgill, MD, Atul Rao, MD, Francis Rosato, MD, Paul DiMuzio, MD, Joshua Eisenberg, MD Journal of Vascular Surgery Volume 56, Issue 2, Pages 500-503 (August 2012) DOI: 10.1016/j.jvs.2012.02.057 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 This magnetic resonance image of the abdomen is from a patient who had pain and nausea-predominant symptoms for 8 years prior to being diagnosed with median arcuate ligament (MAL) syndrome. She had previously undergone multiple imaging studies, including computed tomography (CT), endoscopic retrograde cholangiopancreatography, and gastric emptying scan. In this image, severe narrowing at the origin of the celiac artery (arrow) is noted. Journal of Vascular Surgery 2012 56, 500-503DOI: (10.1016/j.jvs.2012.02.057) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Duplex ultrasound on deep expiration (A) revealed elevated velocities at the origin of the celiac artery which normalized with standing and were significantly higher than in inspiration (B), consistent with a diagnosis of median arcuate ligament (MAL) syndrome. Journal of Vascular Surgery 2012 56, 500-503DOI: (10.1016/j.jvs.2012.02.057) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Operative set-up includes (a) a 12-mm supra-umbilical port, (b) right and (c) left 5-mm ports at subcostal margins in the midclavicular line, (d) a 5-mm subcostal port in the right anterior axillary line (for laparoscopic liver retractor), and (e) a mm midepigastric assistant port. Journal of Vascular Surgery 2012 56, 500-503DOI: (10.1016/j.jvs.2012.02.057) Copyright © 2012 Society for Vascular Surgery Terms and Conditions