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Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum: an anatomical feasibility study

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Abstract

Pelvic ring injuries or acetabular fractures present a challenge to trauma surgeons. Recently, endoscopic dissection techniques for visualization of the anterior pelvic ring and acetabulum have been presented. Robotic-assisted surgical systems offer advantages in terms of improved visualization and easier instrument handling. The aim of this pilot anatomic study was to verify the feasibility of robotic-assisted plate osteosynthesis on the anterior pelvic ring and acetabulum. The experiment was performed on a human whole body specimen. The DaVinci system with standard instruments as used in RARP was used. After docking the system, the anterior pelvic ring was first prepared as previously described for the endoscopic techniques. This was followed by dissection of both acetabula analogous to pelvic lymphadenectomy as performed during RARP. After the dissection was performed along the pelvic brim up to the iliosacral joint, the complete anterior column of the acetabulum including quadrilateral surface and incisura ischiadica major could be visualized. Finally, robotic-assisted endoscopic plate osteosynthesis was performed on the symphysis and anterior acetabular column as previously described in the endoscopic techniques. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum is feasible with the available robotic-assisted systems. Due to the excellent freedom of movement of the robotic arms, combined with the magnifying 3D visualization of the system, highly accurate preparation of the situs in preparation for plate osteosynthesis can be performed. The question of reduction of dislocated fractures remains open and is the subject of further investigation. Compared with conventional laparoscopy, robotic-assisted preparation nevertheless appears to offer an advantage in view of the complexity of the operation.

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Acknowledgements

We sincerely thank Mrs. Catharina Scheuermann-Poley for editing this manuscript in the English language.

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The authors have not disclosed any funding.

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Authors and Affiliations

Authors

Contributions

MAK: Conceptualization, Methodology, Investigation, Writing—Original Draft, Visualization, Supervision. AT: Conceptualization, Investigation, Writing—Review & Editing, Project administration. JJ: Investigation, Writing – Review & Editing. BH: Resources, Writing—Review & Editing. AL: Resources, Writing—Review & Editing. MH: Resources, Writing—Review & Editing. TH: Writing – Review & Editing. SCH: Writing—Review & Editing, Project administration. BA: Investigation, Writing—Review & Editing.

Corresponding author

Correspondence to Markus A. Küper.

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The authors declare no conflict of interest.

Ethical approval

The cadaver studies were performed at the Institute of Clinical Anatomy and Cell Analysis of the Eberhard Karls University in Tübingen, Germany. The rules of the Declaration of Helsinki were strictly followed throughout the cadaver study. The body donors in the Institute of Clinical Anatomy and Cell Analysis at the University of Tübingen gave their written consent during their lifetime for the use of their bodies both for the education of students in the context of medical studies and the training and further education of surgeons as well as for the development of new surgical techniques. The work presented falls within the scope of the consent described, so that no separate ethics vote needs to be obtained.

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Küper, M.A., Trulson, A., Johannink, J. et al. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum: an anatomical feasibility study. J Robotic Surg 16, 1401–1407 (2022). https://doi.org/10.1007/s11701-022-01381-1

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  • DOI: https://doi.org/10.1007/s11701-022-01381-1

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