Technique and outcomes of robotic median arcuate ligament release in 52 patients: A unique collaboration between minimally invasive and vascular surgeons

Background Despite previous reports of robotic-assisted release for median arcuate ligament syndrome (MALS), the safety and efficacy of this approach have been difficult to establish due to the rarity of the disease. We aimed to present our experience at a tertiary surgery referral center. Methods We performed a retrospective analysis of all robotic-assisted median arcuate ligament release (rMALR) performed at our institution from 7/2019 to 5/2025. The diagnosis was made based on symptoms at presentation, celiac artery duplex ultrasound, and findings on computed tomographic angiography. The primary outcomes include resolution of symptoms at 6 weeks, 1 year, and 2 years follow-up. Secondary outcomes include resolution of narcotic use, operative time, 30-day mortality, length of stay, and postoperative complications. Results 52 patients underwent robotic MALR, 94% were females, with a mean age of 39 (18.2–52) years and a mean BMI of 21.2 kg/m ² . The most common presenting symptoms were postprandial pain (98%) and weight loss (81%). Celiac stenosis greater than 70% was observed in all cases. Fifty-one (98%) cases were completed robotically; one case required conversion to laparotomy. The mean operative time was 224 (95–310) minutes, and the mean blood loss was 463 (25–850) ml. Follow-up duration was 38 (9–77) months. Resolution of symptoms was 96%, 92%, and 88% at 6 weeks, 1 year, and 2 years follow-up, respectively. Conclusions Our experience demonstrates that robotic MALR is safe and effective in selected patients. A multidisciplinary approach and thorough preoperative workup are key to the successful treatment of MALS.