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Robotic Assisted Nutcracker Syndrome Management: A Case Series
Jon Vandenberg, Young Erben, Sam Farres, Enrique Elli, Camilo Polania, Camila Esquetini Vernon
Mayo Clinic Florida, Jacksonville, FL
OBJECTIVES: We reviewed our single institution's experience treating nutcracker syndrome in the modern era. Nutcracker syndrome is a rare vascular disorder involving compression of the left renal vein between the superior mesenteric artery and the aorta or the aorta and spine. Historically, open surgery was the mainstay of treatment. While the use of minimally invasive surgery (MIS) for this condition is currently limited, we demonstrate novel robotic-assisted surgical techniques in the management of nutcracker syndrome.
METHODS: We reviewed five robotic-assisted cases for the treatment of nutcracker syndrome at our institution. All patients were female, with ages ranging from 19 to 53 years. All patients underwent an extensive workup, including a CT scan or venogram, to confirm the diagnosis. Preoperative imaging and operative techniques are presented in a video format.
RESULTS: Our institution has successfully completed five novel robotic-assisted operations for nutcracker syndrome. The first two cases involved a left gonadal vein transposition to the left common iliac vein to treat both anterior and posterior nutcracker syndrome. Case three was a left gonadal vein transposition to the inferior vena cava (IVC) for anterior nutcracker syndrome in a patient who previously had a left iliac vein stent. The fourth case involved a left renal vein patch angioplasty and interposition graft with PTFE for anterior nutcracker syndrome. Case five highlighted a left renal vein transposition to the IVC with PTFE for anterior nutcracker syndrome.
CONCLUSIONS: Our review demonstrates the practicality of robotic-assisted surgery for treating nutcracker syndrome. Although robotic surgery is widely used across most surgical specialties, its adoption in vascular surgery has been very limited. We have shown the feasibility of using novel robotic-assisted approaches for the surgical management of this condition and believe that with continued experience, robotic surgery can have a significant future in vascular surgery.
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