Robotic Decompression of Celiac Axis for Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome (MALS), also called celiac artery (CA) compression syndrome or Dunbar syndrome, is a rare clinical condition that involves compression of the celiac artery by median arcuate ligament at its origin. It is more common in young females and presents with weight loss, postprandial colicky pain, and nausea. It is a diagnosis of exclusion. Workup includes computed tomography (CT) with contrast, dynamic magnetic resonance imaging (MRI), and duplex scan. Imaging usually reveals narrowing of the celiac artery due to compression and downward angulation, leading to “fishhook” appearance. Duplex scan shows increased pressure in the celiac axis. Incising the median arcuate leads to symptomatic relief. Robotic approach provides a unique opportunity for meticulous dissection and precise incision of the ligament with faster recovery.