{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T01:11:48Z","timestamp":1752282708647,"version":"3.40.5"},"reference-count":10,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T00:00:00Z","timestamp":1632614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In median arcuate ligament syndrome (MALS), a hyperplastic MAL causes compression and stenosis of the celiac artery (CA). The treatment involves releasing the external pressure on this artery by dissecting the ligament. However, it is difficult to identify the artery because of its deep anatomical location. Stereotactic navigation provides real\u2010time information regarding the surgical instrument's location on computed tomography (CT) images. We utilized this system to overcome the difficulty of anatomical identification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Surgical Technique<\/jats:title><jats:p>We present a case of aneurysm rupture caused by MALS, which was treated with laparoscopic MAL dissection with real\u2010time stereotactic navigation. Surgery was performed in a hybrid operating room with three\u2010dimensional C\u2010arm CT (Artis Zeego, Siemens) and an installed Curve navigation system (BrainLab). Preoperative CT images were aligned with intraoperative C\u2010arm CT\u2010like images and the surgical instrument position was projected onto preoperative CT images. After the left gastric artery isolation, the fibrous tissue surrounding the left gastric artery was dissected toward the CA while confirming the location of the CA and aortic wall using the navigation system. The CA's diameter was dilated from 1.8 to 2.6\u2009mm with intraoperative angiography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This is the first report of laparoscopic MAL dissection using real\u2010time stereotactic navigation. Although navigation setting was time\u2010intensive, this system helped us understand the anatomical structures and in safely and precisely dissecting the MAL.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ases.12990","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T01:30:54Z","timestamp":1632706254000},"page":"443-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Laparoscopic surgery for median arcuate ligament syndrome using real\u2010time stereotactic navigation"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5168-8664","authenticated-orcid":false,"given":"Yuki","family":"Aisu","sequence":"first","affiliation":[{"name":"Department of Surgery Kyoto University Graduate School of Medicine  Kyoto 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