Median arcuate ligament syndrome (MALS) is a rare vascular compression disorder. Its surgical management becomes particularly complex in patients with hematological conditions like paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia (AA), due to risks of thrombosis and bleeding. A 29-year-old male with PNH and AA presented with postprandial epigastric pain. CT angiography revealed compression of the celiac artery consistent with MALS. He underwent robotic-assisted median arcuate ligament release. Intraoperatively, two inferior phrenic arteries were identified, which were anterior to MAL; one preserved, one ligated. Postoperative recovery was uneventful, with no transfusion required, no postprandial pain. Robotic MALS release is feasible even in high-risk hematologic patients. This may represent one of the first such cases described.