MALS with Trinity

A 17 year old female with a 1 year history of chronic pain was found to have celiac artery compression and angulation on a CT angio

The procedure used 5 ports, 4 5-millimeter ports and 1 3-millimeter port

The ability to seal and cut safely with no heat spread is key for the entirety of the procedure

Identifying the right crus and where the right and left crus come together are critical for this procedure

There was unusually a large amount of inflammation in this area and a number of enlarged inflammatory nodes

Dissecting off inflamed nodes is critical in identifying the celiac trunk and to prevent inadvertent injury to the hepatic artery

The fibrous tissue in this area seemed to be impinging on the hepatic artery

A vessel loop was placed around the left gastric artery for traction and secured with 5 millimeter clips

It is necessary to divide celiac plexus nerve fibers to fully open up the area around the celiac trunk

All the energy is between the jaws and there is absolutely no heat spread outside of the jaws with the Trinity device

The lack of heat spread allows dissection, sealing, and dividing tissues while resting on the hepatic artery, celiac trunk, stomach, and other structures

The curved jaws allow better orientation to divide the fibers of the right crus and expose the median arcuate ligament

Two-hand dissection greatly enhances the surgery by allowing dissection, grasping tissue, and elevating planes with both hands

As the median arcuate ligament is divided, the celiac trunk expands and fills into view, showing significant compression of the structure

The ligament must be divided up to the insertion of the celiac trunk on the aorta to ensure complete division

The surgery lasted 90 minutes

The patient was discharged to home with complete resolution of her symptoms the following day