Full endoscopic anterior intrapelvic plate osteosynthesis: a cadaveric feasibility study

Abstract

In this investigation, it was assumed that it must be possible to visualize the intrapelvic aspect as accustomed by pelvic surgeons using the anterior intrapelvic (modified Stoppa) approach. Moreover, it was hypothesized, that plate mountings will not only be possible for the symphysis but also at the supra- and infrapectineal aspect as well as to the posterior column. Ten anonymized cadaveric specimens were included in this study. A standard laparoscopic totally extraperitoneal (TEP) approach was used. A total of 10 landmarks were defined that are usually within reach in the open anterior intrapelvic (AIP) approach. Moreover, five different plate mountings were tested. The locations were chosen in accordance with the indication spectrum suitable for open surgery through the traditional AIP approach. It was possible to gain intrapelvic visibility in seven of ten cases. In all of those seven cases, it was technically possible to place plates to the symphysis, superior pubic ramus, as well as longer anterior column plates up to the aspect posterior of the acetabulum. In the last four of the seven cases, it was possible to mount plates to the infrapectineal aspect as well as the posterior column, too. The team, previously trained in arthroscopic surgical techniques as well as pelvic trauma surgery, observed a steep learning curve. This investigation demonstrated, that endoscopic anterior intrapelvic plate osteosynthesis was feasible in the majority of the cases in a series of ten cadaveric models. New instruments will be needed such as extra-long rasp elevators, ball-spikes as well as devices to hold and position plates and extra-long self-holding screwdrivers. With these, endoscopic pelvic surgery will likely be a realistic option for selected pelvic trauma cases in the future.

Different coupling mechanisms for a novel modular plate in acetabular fractures—a comparison using a laparoscopic model

“…In fact, David et al ( 16 ) demonstrated recently that an extraperitoneal endoscopic dissection of the pelvis offers a similar visibility when compared to an open approach ( 16 ). Moreover, Hartel et al ( 17 ) introduced in a cadaver study a fully endoscopic approach for anterior intrapelvic surgery and plate osteosynthesis ( 17 ). However, to ensure successful osteosynthesis, especially with such a minimally invasive approach, a feasible implant technology is required.…”

The infraacetabular screw versus the antegrade posterior column screw in acetabulum fractures with posterior column involvement: a biomechanical comparison

“…Traditionally, fixation of the anterior column is performed by plate and screw osteosyntheses and fixation of the posterior column by an antegrade posterior column screw via an ilioinguinal approach as a standard [ 18 – 24 ]. In the last few years, a trend towards less invasive techniques in acetabular fracture surgery could be observed [ 25 – 28 ]. The use of less invasive approaches has been proven to be beneficial, especially in geriatric patients, which is why the ilioinguinal approach has been replaced by the modified Stoppa (AIP) approach as well as the Pararectus approach [ 18 , 23 , 25 , 28 – 32 ].…”

“…In the last few years, a trend towards less invasive techniques in acetabular fracture surgery could be observed [ 25 – 28 ]. The use of less invasive approaches has been proven to be beneficial, especially in geriatric patients, which is why the ilioinguinal approach has been replaced by the modified Stoppa (AIP) approach as well as the Pararectus approach [ 18 , 23 , 25 , 28 – 32 ]. However, the implantation of an antegrade posterior column screw requires an additional small incision to the first ilioinguinal window, if the plate osteosynthesis is performed via the modified Stoppa approach, while this will be not necessary with the Pararectus approach [ 19 , 21 , 31 , 33 , 34 ].…”

Percutaneous Fixation for Traumatic Symphysis Pubis Disruption—Are the Results Superior Compared to Open Techniques? A Systematic Review and Meta-Analysis of Clinical and Biomechanical Outcomes

“…With the improvement of intraoperative imaging, several alternative less traumatic fixation methods have been recently introduced and gained popularity as they could reduce operative time and morbidity. Minimally invasive [10] or endoscopic plate fixation [11,12], percutaneous cannulated screw fixation (PCSF) [8,13], Endobutton technique for dynamic fixation [10], and tape suture fixation [14] promise not only adequate stability of the disrupted anterior pelvic ring but also smaller skin incisions, less soft tissue trauma, and minimal blood loss [2]. However, published reports of PCSF for SPD are quite rare, and the overall value and superiority of the technique remain unclear.…”