Short- and intermediate-term clinical outcome comparison between laparoscopic and robotic-assisted median arcuate ligament release.

While laparoscopic median arcuate ligament (MAL) release remains the most common approach, robotic-assisted MAL release has been increasingly performed by several institutions. This study aims to compare surgical outcomes between laparoscopic and robotic-assisted MAL release. This is a retrospective study of patients undergoing laparoscopic and robotic-assisted MAL release in a teaching hospital from January 1999 to December 2018. Intraoperative and postoperative outcomes as well as short- and intermediate-term clinical outcomes were compared between the two groups. A total of 16 laparoscopic and 18 robotic cases were included. Demographics and baseline characteristics were similar between the two comparison groups. Median operative time was shorter in the robotic group [179.5 (IQR 127.3-225) vs. 106 (IQR 80.8-122.8) minutes; p < 0.001]. The rates of conversion to open operation were similar in both groups (6.3% vs. 5.6%, p = 0.99). Conversions to laparotomy were performed due to bleeding and extensive adhesions in one laparoscopic case and due to technical difficulties in a patient with narrow body habitus in the robotic group. Postoperative complication rates were similar (12.5% vs. 16.7%, p = 0.99), all in grade I and II. Complete pain resolution rates (37.5% vs. 44.4%, p = 0.93), symptom recurrence rates (37.5% vs. 27.8%, p = 0.93), and overall clinical improvement at last follow-up (87.5% vs. 77.8%, p = 0.66) were not statistically different. Both laparoscopic and robotic-assisted MAL release offer similar short- and intermediate-term clinical outcomes. A shortened operative time may be achieved by incorporating the robot platform.