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5 minutes

The procedure was performed in accordance with the principles of the Declaration of Helsinki and the guidelines of the institutional human research ethics committee. The patient provided both written and oral informed consent for the use of her medical data and surgical video for educational and scientific purposes.
1. Setup
NOTE: The procedure is performed by two surgeons: a console surgeon and a tableside surgeon, who is positioned between the patient&#8217;s legs, allowing comfortable and close access to the surgical field.
<ol>
	<li>Positioning
	<ol>
		<li>Place the patient in the supine French position. Adduct the right arm alongside the body, and abduct the left arm.</li>
		<li>Tilt the operating table 10&#176; in reverse Trendelenburg and 10&#176; to the right to optimize exposure of the upper abdomen. 
		&#8203;NOTE: After division of the ligament of Treitz, tilt the operating table 10&#176; to the left to facilitate the Kocher maneuver.</li>
	</ol>
	</li>
</ol>
2. Docking
<ol>
	<li>Pneumoperitoneum
	<ol>
		<li>Establish pneumoperitoneum using a Veress needle at Palmer&#8217;s point and insufflate CO&#8322; to a pressure of 10&#8211;12 mmHg. Place markings for the trocars after insufflation.</li>
	</ol>
	</li>
	<li>Trocar placement
	<ol>
		<li>Position the camera port on a line from 2 cm to the right of the umbilicus along a line toward the right costal margin (R3), trocar 11&#8211;12 cm from the costal margin.</li>
		<li>Place three additional robotic trocars approximately 7 cm apart: two on the right side (R1&#8211;R2), with the R1 slightly more cranial, and one on the left side (R4). Place two table-side surgeon trocars 7 cm from trocars R2-3-4 (L1&#8211;L2).</li>
		<li>Dock the robot from the patient&#8217;s right cranial side. Assign instruments as follows: R1 with Cadiere forceps, R2 with a monopolar cautery hook, R3 with the camera, and R4 with bipolar forceps. 
		&#8203;NOTE: The table-side surgeon sits between the patient&#8217;s legs, which are positioned horizontally, allowing comfortable and close access to the surgical field.</li>
		<li>Use a Maryland jaw sealer/divider device in L2 and forceps in L1 (Figure 2).</li>
	</ol>
	</li>
</ol>
3. Surgical procedure
<ol>
	<li>Division of the ligament of Treitz
	<ol>
		<li>Retract the greater omentum and transverse colon cranially to expose the ligament of Treitz and lift the transverse mesocolon with R1.</li>
		<li>Dissect and divide the ligament of Treitz to allow free mobilization of the duodenum. Continue the mobilization until the inferior caval vein is visualized and the duodenum is tension-free, allowing it to be repositioned inferiorly and to the right, away from the aortomesenteric angle.</li>
		<li>Throughout the procedure, take great care to prevent any serosa tears to the duodenum and proximal jejunum.</li>
	</ol>
	</li>
	<li>Hepatic flexure mobilization
	<ol>
		<li>Adjust the operating table by tilting it 10&#176; to the left. Dissect and completely mobilize the hepatic flexure of the colon to achieve full visualization and release of the duodenum.</li>
		<li>To avoid injury to the right colonic vessels during hepatic flexure takedown, create a tunnel between the omentum and the mesocolon, hereby mobilizing the right colonic vessels dorsally.</li>
	</ol>
	</li>
	<li>Kocher maneuver
	<ol>
		<li>Incise the peritoneal reflection along the lateral border of the second portion of the duodenum and the head of the pancreas for the Kocher maneuver. Continue dissection in the avascular retroperitoneal plane, allowing mobilization of the duodenum and pancreatic head medially while preserving the surrounding vascular structures.</li>
		<li>During this maneuver, complete mobilization of the colic flexure by separating the colon from the duodenum and the pancreatic head. Care is taken to avoid injuries to the right colonic vessels by first creating a tunnel between the omentum and the mesocolon.</li>
		<li>Rotate the colon toward the sigmoid colon (by the table-side surgeon) to prevent excessive traction on the SMV and its branches.</li>
		<li>Extend this maneuver to visualize the left renal vein, to completely mobilize the duodenum and pancreatic head. Take particular care to avoid injury to the inferior caval vein while maintaining the dissection within the avascular retroperitoneal plane.</li>
	</ol>
	</li>
	<li>Assessment of adequate mobilization
	<ol>
		<li>Retract the proximal jejunum 10&#8211;20 cm through the ligament of Treitz defect into the right supracolic upper quadrant to verify adequate mobilization.</li>
	</ol>
	</li>
</ol>
4. Undocking and closure
<ol>
	<li>Undock the robotic system and remove the trocars. Remove the robot from the operating table.</li>
	<li>Close the fascia of the port sites and close the skin with an intracutaneous suture.</li>
</ol>

<ol>
	<li>England J, Li N. Superior mesenteric artery syndrome: A review of the literature. J Am Coll Emerg Physicians Open. 2021;2(3):e12454.</li>
	<li>Raissi B, Taylor BM, Taves DH. Recurrent superior mesenteric artery (Wilkie&#39;s) syndrome: A case report. Can J Surg. 1996;39(5):410-6.</li>
	<li>Van Horne N, Jackson JP. Superior mesenteric artery syndrome. StatPearls. 2023.</li>
	<li>Sahni S, et al. Superior mesenteric artery syndrome: The dark side of weight loss. Cureus. 2017;9(11):e1859.</li>
	<li>Lee TH, et al. Superior mesenteric artery syndrome: Where do we stand today? J Gastrointest Surg. 2012;16(12):2203-11.</li>
	<li>Strong EK. Mechanics of arteriomesenteric duodenal obstruction and direct surgical attack upon etiology. Ann Surg. 1958;148(5):725-30.</li>
	<li>Dekonenko C, et al. Ligament of Treitz release with duodenal lowering for pediatric superior mesenteric artery syndrome. J Surg Res. 2020;254:91-5.</li>
	<li>Wasef K, et al. Robotic modified Strong procedure for superior mesenteric artery syndrome. Clin Case Rep. 2023;11(7):e7651.</li>
	<li>Jain R. Superior mesenteric artery syndrome. Curr Treat Options Gastroenterol. 2007;10(1):24-7.</li>
	<li>Unal B, et al. Superior mesenteric artery syndrome: CT and ultrasonography findings. Diagn Interv Radiol. 2005;11(2):90-5.</li>
	<li>Burrington JD. Superior mesenteric artery syndrome in children. Am J Dis Child. 1976;130(12):1367-70.</li>
	<li>Konstantinidis H, Charisis C, Kottos P. Robotic Strong&#39;s procedure for the treatment of superior mesenteric artery syndrome: Description of surgical technique on occasion of the first reported case in the literature. Int J Med Robot Comput Assist Surg. 2018;14(3):e1876.</li>
	<li>Chatziisaak D, et al. Comparison of 2D and 3D visualization in minimally invasive and robotic surgery: A systematic review. Surg Endosc. 2026;40(3):1828-36.</li>
	<li>Lin CY, Lin BY, Kang PL. Duodenal obstruction after elective abdominal aortic aneurysm repair: A case report. Kaohsiung J Med Sci. 2004;20(10):501-5.</li>
	<li>Oka A, et al. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases. 2023;11(15):3369-84.</li>
	<li>White A, et al. A delayed presentation of superior mesenteric artery syndrome treated with robotic-assisted Strong procedure. Cureus. 2024;16(8):e67527.</li>
	<li>Jo JB, Song KY, Park CH. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: Report of a case. Surg Laparosc Endosc Percutan Tech. 2008;18(2):213-5.</li>
</ol>

MGB, SF, and FD are proctors for Intuitive Surgical. The other authors have nothing to disclose.

The SMA syndrome, also known as Wilkie syndrome, cast syndrome, or chronic duodenal ileus9, remains a rare and often underdiagnosed condition due to the nonspecific nature of its clinical presentation and the variability of radiological findings1,4. In the present case, although the aortomesenteric angle was within normal limits, the reduced aortomesenteric distance and the patient&#8217;s symptoms were highly suggestive of SMA syndrome10. In addition, symptom onset followed a 10 kg weight loss, which, in accordance with the established pathophysiology of SMA syndrome, was considered a predisposing factor. Depletion of the mesenteric fat pad is known to reduce the aortomesenteric angle and distance, thereby predisposing to compression of the third portion of the duodenum3. This highlights the importance of correlating imaging findings with clinical presentation, as reliance on a single radiological parameter may lead to misdiagnosis or delayed treatment.
Conservative management with nutritional support represents the first-line approach and is effective in a subset of patients, particularly when weight gain can be obtained. However, in chronic or refractory cases such as the one presented, surgical intervention may be required5. Duodenojejunostomy has traditionally been considered the surgical reference standard, offering high success rates but at the cost of creating an intestinal bypass. In contrast, the Strong procedure aims to restore physiological anatomy by mobilizing the duodenum and relieving vascular compression without the need for an intestinal anastomosis6,8,11.
A limitation of the Strong procedure has been the technical difficulty in achieving adequate mobilization of the duodenum, particularly in the retroperitoneal space using traditional laparoscopy. In this context, robotic surgery provides significant advantages, including enhanced three-dimensional visualization and greater precision in dissection. These features are particularly beneficial when working around critical vascular structures such as the inferior caval vein12,13. In addition, the effectiveness of the Robot Strong procedure may depend on the underlying anatomical configuration. Patient selection is likely crucial for the success of the Strong procedure. In our view, it may be particularly suitable for patients in whom the aortomesenteric distance is reduced only at the level of the duodenojejunal junction but increases more caudally, allowing complete duodenal mobilization to relocate the third portion of the duodenum into a wider aortomesenteric space. Conversely, duodenojejunostomy may remain the preferred option in patients in whom the aortomesenteric distance remains reduced along the entire course of the third portion of the duodenum, as mobilization alone may be insufficient to relieve the vascular compression. However, these considerations represent our anatomical hypothesis and should be interpreted with caution, as comparative evidence is currently lacking. Moreover, previous reports have suggested that SMA syndrome may occur despite a normal aortomesenteric angle because of anatomical variations, including a congenitally short or high ligament of Treitz or an abnormally low origin of the SMA, resulting in localized duodenal compression despite non-classical imaging findings. Although these anatomical variations cannot be confirmed in the present case, the increased aortomesenteric distance observed more caudally is consistent with such a mechanism and supports the hypothesis that patients with localized compression related to the ligament of Treitz may represent a subgroup in whom the Strong procedure could be considered as an alternative to duodenojejunostomy14,15.
Several technical aspects are crucial for the success of the procedure. First, complete division of the ligament of Treitz is essential to achieve full duodenal mobilization. Second, an extended Kocher maneuver is required to ensure that the duodenum is completely tension-free. Third, mobilization of the hepatic flexure further contributes to adequate release of the duodenum8,16. In addition, intraoperative table repositioning, as described in this protocol, facilitates exposure and allows confirmation of effective decompression.
In the present case, the Robot Strong procedure was associated with excellent clinical and radiological outcomes, and the short operative time, minimal blood loss, and uneventful postoperative course further support the safety and feasibility of this approach. Nevertheless, when mobilization is insufficient, conversion to duodenojejunostomy should be performed17.
These findings confirm the technical feasibility and clinical effectiveness of the robot-assisted Strong procedure in relieving duodenal compression in patients with SMA syndrome.

Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare cause of proximal intestinal obstruction resulting from compression of the third portion of the duodenum between the aorta and the superior mesenteric artery1,2. It is typically associated with a reduced aortomesenteric distance (&#60;10 mm) and angle (&#60;25&#176;), often related to significant weight loss or anatomical predisposition3.
Patients usually present with postprandial abdominal pain, early satiety, nausea, and weight loss, frequently leading to delayed diagnosis due to the nonspecific nature of symptoms4. Conservative management, including nutritional support, represents the first-line treatment. In some patients, weight gain will increase the aorto-mesenteric distance and the angle. However, surgical intervention may be indicated in patients with persistent or severe symptoms3, particularly when these significantly impair oral intake and quality of life. No universally accepted duration of conservative treatment has been established, and the decision should be individualized according to symptom severity, nutritional status, and response to medical therapy. In these patients, duodenojejunostomy has traditionally been considered as the standard surgical approach5. However, the Strong procedure, consisting of the division of the Treitz&#8217; ligament with full mobilization of the duodenum, may represent a physiological alternative aimed at relieving vascular compression without the need for intestinal bypass6,7. The advent of robotic surgery has enhanced the feasibility of this technique by providing improved visualization and precise dissection in the retroperitoneal space7,8. Here, we present a Robot Strong procedure for SMA syndrome, highlighting its technical aspects and clinical outcomes.
We present the case of a 38-year-old woman with a history of laparoscopic cholecystectomy. The patient had a history of significant weight loss, with a body weight of 61 kg at presentation compared with approximately 70 kg previously. This weight loss preceded the onset of symptoms. She presented at the clinic with a 2-year history of postprandial abdominal pain, nausea, and bloating. The pain typically occurred within 30 min after meals, reaching an intensity of 8/10 on the numerical rating scale, and was associated with abdominal distension and nausea. Symptoms were partially relieved by lying in the left lateral position with flexed knees and usually resolved within 30&#8211;60 min. As a result, the patient adapted her eating habits, consuming small, frequent meals throughout the day.
The diagnosis of SMA syndrome is based on the combination of clinical presentation and imaging findings. In contrast-enhanced computed tomography (CT), SMA syndrome is typically characterized by a reduced aortomesenteric distance (&#60;10 mm), a reduced aortomesenteric angle (&#60;25&#176;), and secondary signs of proximal duodenal obstruction, including duodenal dilatation and stasis. Upper gastrointestinal contrast passage studies may serve as an adjunctive examination by demonstrating delayed passage through the third portion of the duodenum.
In this case, a contrast-enhanced CT imaging demonstrated a reduced aortomesenteric distance of 8.1 mm, with mild dilation of the proximal duodenum and signs of duodenal stasis, but with the aortomesenteric angle measured 52&#176;, within normal limits (Figure 1). However, the diagnosis was based on the combination of objective imaging findings and a highly suggestive clinical presentation. The patient had persistent disabling postprandial pain, nausea, and bloating for two years despite conservative management, with marked limitation of oral intake, positional symptom relief, and previous significant weight loss. Together with the reduced aortomesenteric distance, proximal duodenal dilatation, and duodenal stasis on CT, these findings were considered sufficiently suggestive of SMA syndrome despite the normal aortomesenteric angle. Therefore, an additional contrast passage video was not performed, as it was not expected to alter the multidisciplinary treatment recommendation.
The case was discussed in two multidisciplinary team (MDT) meetings in our center (vascular and benign pancreato-biliary disease). Both MDTs concluded that the clinical presentation and imaging findings were suggestive of SMA syndrome. The patient had experienced persistent disabling symptoms for 2 years despite conservative management. As no universally accepted criteria exist regarding the optimal duration of conservative treatment, the decision to proceed with surgery was individualized, taking into account symptom severity, failure of conservative management, duration of symptoms, and the patient&#39;s wishes. Initially, a robot-assisted duodenojejunostomy with Roux-en-Y reconstruction was considered. However, careful preoperative CT evaluation demonstrated that the aortomesenteric distance increased rapidly more caudally, suggesting that the vascular compression was confined to the level of the ligament of Treitz. Therefore, a Robot Strong procedure was considered a physiological alternative, allowing complete duodenal mobilization and relief of the obstruction without the need for an intestinal bypass. The patient underwent a Robot Strong procedure, consisting of the division of the ligament of Treitz and full duodenal mobilization.

<table><tbody><tr><td>Assistant trocars</td><td>Applied</td><td>&lt;a href=&quot;https://pdf.medicalexpo.it/viewerCatalog-en/applied-medical/kii/74928-152615-_2.html#open&quot;&gt;CTF73&amp;nbsp;&amp;nbsp;&lt;/a&gt;</td><td>L1 assistant port (https://pdf.medicalexpo.it/viewerCatalog-en/applied-medical/kii/74928-152615-_2.html#open)</td></tr><tr><td>Bipolar Forceps</td><td>Intuitive Surgical</td><td>&lt;a href=&quot;https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf&quot;&gt;470172&lt;/a&gt;</td><td>Robotic instrument R4 (https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf)</td></tr><tr><td>Cadiere Forceps</td><td>Intuitive Surgical</td><td>&lt;a href=&quot;https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf&quot;&gt;471049&lt;/a&gt;</td><td>Robotic instrument R1 (https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf)</td></tr><tr><td>da Vinci Surgical System</td><td>Intuitive Surgical</td><td>IS4000&amp;nbsp;&amp;nbsp;</td><td>Robotic platform (https://www.intuitive.com/)</td></tr><tr><td>Laparoscopic grasping forceps</td><td>Karl Storz</td><td>&lt;a href=&quot;https://www.lapspay.com/cps/rde/xbcr/karlstorz_assets/ASSETS/3641936.pdf?utm_source=chatgpt.com&quot;&gt;33310OD&amp;nbsp; https://www.lapspay.com/cps/rde/xbcr/karlstorz_assets/ASSETS/3641936.pdf?utm_source=chatgpt.com&lt;/a&gt;</td><td>Assistant instrument L1</td></tr><tr><td>LigaSure Maryland Device</td><td>Medtronic/Covidien</td><td>LF1937&amp;nbsp;&amp;nbsp;</td><td>Table-side energy device (L2) (sealing/laparoscopic-instruments/ligasure-maryland-jaw-sealer-divider-nano-coating.html or https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/vessel-sealing/ligasure-technology.html)&amp;nbsp;</td></tr><tr><td>Monopolar Cautery Hook</td><td>Intuitive Surgical</td><td>470183</td><td>Robotic instrument R2 (https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf)</td></tr><tr><td>Robotic camera 30&amp;deg;</td><td>Intuitive Surgical</td><td>470057</td><td>R3 camera arm ( https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf)</td></tr><tr><td>Robotic trocars</td><td>Intuitive Surgical</td><td>470002</td><td>Four robotic ports (https://www.intuitive.com/en-us/-/media/ISI/Intuitive/Pdf/da-vinci-x-xi-instruments-accessories-catalog.pdf)</td></tr><tr><td>Veress Needle</td><td>ConMed</td><td>&lt;a href=&quot;https://www.kebomed.no/files/577/verres_needle_disposable_insufflation.pdf&quot;&gt;60-6050-002&amp;nbsp; https://www.kebomed.no/files/577/verres_needle_disposable_insufflation.pdf&lt;/a&gt;</td><td>Pneumoperitoneum at Palmer&amp;rsquo;s point</td></tr></tbody></table>

robot strong procedure for superior mesenteric artery (wilkie) syndrome

Robot Strong Procedure for Superior Mesenteric Artery (Wilkie) Syndrome

Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction resulting from compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. The Strong procedure offers a physiological alternative to duodenojejunostomy by performing full duodenal mobilization, thereby omitting the need for an intestinal bypass (e.g., duodenojejunostomy). We present the case of a woman with chronic postprandial abdominal pain, nausea, and bloating, refractory to conservative management. When the patient positioned herself in a left lateral fetal position, the complaints resolved. Preoperative imaging demonstrated a reduced SMA-aorta distance (8.1 mm) with a normal aortomesenteric angle (52.1&#176;), as well as signs of duodenal stasis, all potentially consistent with SMA syndrome. The patient underwent a Robot Strong procedure consisting of division of the ligament of Treitz and full duodenal mobilization, including Kocherization. The postoperative course was uneventful. At 6 weeks of follow-up, symptoms were resolved completely, with improved oral intake. At imaging follow-up, the duodenum was placed more caudally, fitting with the expected outcome. These findings confirm the feasibility and clinical effectiveness of the Robot Strong procedure in highly selected patients with SMA syndrome.

The operative time was 70 min, with negligible intraoperative blood loss. No intraoperative complications occurred. The postoperative course was uneventful, and the patient was discharged on postoperative day 3 in good clinical condition.
At the 6-week follow-up, the patient reported near complete resolution of postprandial abdominal pain. Oral intake significantly improved, allowing the patient to tolerate larger meal portions without discomfort. Occasional mild abdominal bloating was still reported but did not impact daily activities. Postoperative CT imaging confirmed successful mobilization of the duodenum, with an increased aortomesenteric distance (11.8 mm) and angle (96.2°) (Figure 3A). The third portion of the duodenum showed a vertical course, with no evidence of residual obstruction (Figure 3B,C). At the 6-month follow-up, the patient regained approximately 5 kg and remained symptom-free.
<img alt="CT scan imaging, spinal and abdominal sections, identifying vertebrae and intestinal regions." class="xfigimg" src="/files/ftp_upload/72658/72658fig1.jpg" data-altupdatedat="1789444946000" data-alt="Figure 1"> 
Figure 1: Preoperative CT. (A) Pre-operative CT scan showing an aortomesenteric angle within normal limits (52.1°) with a reduced aortomesenteric distance at the location of the transverse duodenum of 8.1 mm (normal &gt;10 mm). (B) Preoperative coronal CT image showing mild proximal duodenal dilatation. (C) Preoperative axial CT image demonstrating mild proximal duodenal dilatation with retained intraluminal fluid and gas, suggestive of impaired duodenal transit. <a href="https://www.jove.com/files/ftp_upload/72658/72658fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Robotic surgical setup diagram with instruments for abdominal procedure, showing patient positioning." class="xfigimg" src="/files/ftp_upload/72658/72658fig2.jpg" data-altupdatedat="1789444946000" data-alt="Figure 2"> 
Figure 2: Trocars and the patient’s position. <a href="https://www.jove.com/files/ftp_upload/72658/72658fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="CT scan and abdominal image of intestinal obstruction; diagram and clinical diagnosis." class="xfigimg" src="/files/ftp_upload/72658/72658fig3.jpg" data-altupdatedat="1789444946000" data-alt="Figure 3"> 
Figure 3: Surgical field after duodenal mobilization and postoperative CT. (A) Post-operative CT scan showing an increased aortomesenteric angle (96.2°) and distance (11.8 mm). (B) Postoperative CT scan showing a vertical course of the third portion of the duodenum. (C) Surgical field after duodenal mobilization. DII = Second part of duodenum; DIII = Third part of duodenum; IVC = inferior caval vein; ^ = the Treitz angle, or duodenojejunal flexure, has been retracted in the right supracolic upper quadrant to verify adequate mobilization. <a href="https://www.jove.com/files/ftp_upload/72658/72658fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

This protocol demonstrates the key technical steps of a Robot Strong procedure in a patient suspected of superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome.

Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction resulting from compression of the third portion of the ...

A 38-year-old patient was referred due to a longstanding history of postprandial abdominal pain, nausea, and bloating. The pain typically occurred within 30 minutes after meals and was associated with abdominal distension and nausea. Symptoms were partially relieved by lying in the left lateral decubitus position with flexed knees.Preoperative contrast enhanced CT imaging demonstrated a reduced aortomesenteric distance of 8.1 millimeters with mild dilation of the proximal duodenum and signs of duodenal stasis. The aortomesenteric angle measured 52 degrees within normal limits. These findings were considered suggestive of SMA syndrome.Although CT findings were borderline, showing a reduced aortomesenteric distance, but with a normal aortomesenteric angle, the proximal duodenal dilatation, together with the typical postprandial symptoms and a history of rapid weight loss, were highly suggestive for SMA syndrome. For this reason, a contrast swallow study was not performed. Following multidisciplinary team discussion, surgery was recommended after two years of failed conservative management.The patient underwent a robot Strong procedure. The procedure was approved by the Institutional

robot-strong-procedure-for-superior-mesenteric-artery-wilkie-syndrome

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Amsterdam UMC, location University of Amsterdam.  This protocol demonstrates the key technical steps of a Robot Strong procedure in a patient suspected of superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome.

Robot Strong Procedure for Superior Mesenteric Artery (Wilkie) Syndrome

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