Enhanced bone exposure via laparoscopy in acetabulum and pelvic ring surgeries

In orthopaedic surgery, achieving optimal exposure for acetabular and pelvic ring fractures with minimal invasiveness remains a challenge. This study compares bone exposure in key pelvic zones using an endoscopic approach versus the AIP (Modified Stoppa) in cadaveric specimens.

We dissected ten adult cadaveric bodies, obtained from our institution's body donation program, using an extraperitoneal endoscopic dissection on one side and an AIP approach on the other. Bone areas were marked at each step of dissection by drill holes to measure the bone exposure surface for each zone (true and false pelvis) between the laparoscopic and open approaches. A Student's t test was used to compare the exposure areas obtained.

The average age of the cadavers was 83 years, with a balanced representation of genders (60% male, 40% female). Comparison of zones between endoscopy and AIP found for Zone 1: 1.4 cm² (range - 3.813 to 1.013) for AIP with no statistical significance. For Zone 2: 0.5 cm² (range - 1.9141 to 2.9141) for AIP with no statistical significance. For Zone 3: 0,6 cm² (range - 1.0243 to 2.2243) for AIP with no statistical significance. And for Zone 4: 3.5 cm² (1.874; 5.126) for endoscopy with statistical significance (p = 0.001).

Our study demonstrates that the endoscopic method provides comparable visualization of the different pelvic zones compared to the open method (AIP), with enhanced access to Zone 4, a crucial area in managing acetabulum and pelvic ring fractures.

Level V, cadaveric study.