Early outcomes of robotic management of aberrant subclavian artery

Background

Aberrant subclavian artery (ASA), though rare, can cause dysphagia lusoria and significantly affect quality of life. Conventional treatment involves open ligation and division of ASA, but a robotic approach is becoming more popular. This study assessed outcomes in patients undergoing robotic ASA division.

Methods

We retrospectively reviewed 9 patients with dysphagia who underwent robotic division of ASA between 2021 and 2025. Our standard approach is one-stage robotic ligation and division of the ASA, followed by open subclavian-to-carotid transposition (SCT). Patients undergo continued surveillance for potential thoracic endovascular aortic repair (TEVAR) in the event that Kommerell diverticulum (KD) expands. Patient demographics, presentations, aberrant anatomy, operative details, and outcomes were reviewed.

Results

The study cohort had a mean age of 49 years and mean body mass index of 30.5 kg/m². The main presenting symptoms were dysphagia and dyspnea. An aberrant left subclavian artery with right-sided arch was seen in 5 patients; an aberrant right subclavian artery, in 4. Seven patients had KD. Eight patients underwent concurrent SCT; 1 patient had prior TEVAR and carotid-subclavian bypass for large descending thoracic and Kommerell aneurysms. The mean operative time was 169 minutes, and the mean hospital stay was 2 days. There was no postoperative stroke, bleeding, pneumothorax, chyle leak, or mortality; 1 patient experienced transient Horner syndrome. Five patients reported significant improvement in dysphagia, 1 reported moderate improvement, 1 reported mild improvement, 1 reported no change, and 1 was lost to follow-up.

Conclusions

This one-stage hybrid approach—robotic ASA division with open SCT—is safe, with no reported postoperative stroke or mortality, and offers excellent patient satisfaction. It provides a minimally invasive alternative for treating dysphagia lusoria.