Successful robotic-assisted division of symptomatic vascular ring.

A 61-year-old woman presented with the primary complaints of chest heaviness and dysphagia over the past 10 years. Extensive work-up included a computerized tomographic angiography that revealed a right aortic arch with an aberrant left subclavian artery with a vascular ring completed by the fibrotic ligamentum arteriosum connecting the proximal aberrant left subclavian artery to the left pulmonary artery (Figure). The patient was scheduled for robotic-assisted division of the vascular ring and was positioned in an exaggerated right lateral decubitus with single right lung ventilation. Three robotic instrument ports were placed through 1-cm incisions: the camera port was introduced in the 5th intercostal space in the mid-axillary line, the right arm port was introduced through the 3rd intercostal space at the anterior axillary line, and the left arm port was positioned through the 6th intercostal space at the posterior axillary line. The ligamentum arteriosum was dissected and successfully divided (Video). The patient was extubated in the operating room and discharged after 3 days. At last follow-up, her symptoms had resolved.