Enhanced bone exposure via laparoscopy in acetabulum and pelvic ring surgeries

Area of Science:

• Orthopaedic Surgery
• Minimally Invasive Procedures
• Anatomical Exposure

Background:

• Optimal surgical exposure for acetabular and pelvic ring fractures is challenging, particularly with minimally invasive techniques.
• The Anterior Inferior Parietal (AIP) approach is a common open method for pelvic fracture fixation.

Purpose of the Study:

• To compare bone exposure in key pelvic zones using an endoscopic approach versus the AIP (Modified Stoppa) method.
• To evaluate the efficacy of endoscopic techniques in achieving adequate surgical visualization for pelvic fractures.

Main Methods:

• Ten adult cadaveric specimens were dissected using both extraperitoneal endoscopic and AIP approaches.
• Bone exposure areas in true and false pelvis zones were measured and compared.
• Statistical analysis using Student's t test was performed to determine significance.

Main Results:

• Endoscopic approach showed statistically significant enhanced bone exposure in Zone 4 (3.5 cm²; p=0.001).
• No significant differences in bone exposure were found between endoscopic and AIP approaches in Zones 1, 2, and 3.
• Cadavers averaged 83 years, with 60% male and 40% female representation.

Conclusions:

• Endoscopic surgery provides comparable pelvic bone visualization to the AIP approach.
• The endoscopic method offers superior access to Zone 4, critical for acetabular and pelvic ring fracture management.
• This suggests potential for endoscopic techniques in complex pelvic fracture surgery.