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

A nationwide analysis of median arcuate ligament release between 2010 and 2020: a NSQIP Study

“…Although our study was not able to directly assess the conversion rate, only 1 case had concomitant CPT codes 49000 and 49320, which could be translated to a 0.5% conversion rate, though this likely underestimates the true occurrence rate. The conversion rate previously published by our group was 10.3% in a study from 2007 to 2014, however, in a later study from 2018 to 2019 no conversions occurred in 50 cases done with minimally invasive techniques [ 5 , 7 ]. In this regard, it is our institutional practice for MAL release to be performed by a trained minimally invasive surgeon with assistance from a vascular surgeon if needed.…”

“…It is important to point out that in the current study laparoscopic cases were more commonly perform by general surgeons and at the same time, the number of procedures performed by general surgeons increased over the study period. These findings could partially explain the increased adoption of the laparoscopic approach, in addition to the growing evidence published during the same time demonstrating that laparoscopic MAL release is safe [ 4 – 7 ]. In a similar way, this growing evidence in combination to data demonstrating symptomatic improvement can also explain the rising number of cases done over time peaking in 2019.…”

“…Since the first robotic MALR was published in 2007, several studies have shown the safety and feasibility of this approach [ 7 , 13 , 14 , 23 ]. Unfortunately, in our study we were unable to identify robotic cases, and there is even a possibility that some of those classified as laparoscopic had actually been robotic.…”

“…Unfortunately, in our study we were unable to identify robotic cases, and there is even a possibility that some of those classified as laparoscopic had actually been robotic. In that regard, Shin et al demonstrated that both the laparoscopic and robotic-assisted techniques were similar with the only disadvantage of a more proficient assistant needed for laparoscopic cases [ 7 ]. Additional concerns about robotic surgical intervention include the loss of haptic feedback, which may make sensation between the celiac artery, aorta, and overlying nervous and muscular fibers less clear.…”

“…This procedure can be done open, laparoscopic or more recently robotic-assisted. However, there is not enough evidence to help guide surgeons as to which operative approach is superior over the other, with limited data coming from single-institution series [ 4 , 7 , 8 , 11 – 16 ]. In the largest study to our knowledge, no difference was found in postoperative outcomes between the laparoscopic and open approach [ 6 ].…”