Skip to main content

Advertisement

SpringerLink
Log in

EASY (endoscopic approach to the symphysis): a new minimally invasive approach for the plate osteosynthesis of the symphysis and the anterior pelvic ring—a cadaver study and first clinical results

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Minimally invasive surgical approaches to reduce approach-associated morbidity are an interdisciplinary goal in surgery. In principle, the endoscopic approach for the extraperitoneal repair of groin hernias is the minimally invasive variant of the modified Stoppa-approach, which is used for the treatment of pelvic ring injuries in traumatology.

Method

Anatomical feasibility study regarding the plate osteosynthesis of the anterior pelvic ring via a minimally invasive variant of the modified Stoppa-approach.

Results

We present the minimally invasive variant of the modified Stoppa-approach in a human cadaver step by step, both photographically and radiologically. Feasibility of the plate osteosynthesis of the symphysis is presented in a patient with open book injury via the minimally invasive approach using standard laparoscopic instruments.

Conclusion

The plate osteosynthesis of the anterior pelvic ring via the minimally invasive variant of the modified Stoppa-approach is feasible with existing standard laparoscopic instruments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44:1733–44.

    Article  PubMed  Google Scholar 

  2. Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg. 2015;41:349–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Routt ML Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11:584–9.

    Article  PubMed  Google Scholar 

  4. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma. 2006;20:30–6.

    Google Scholar 

  5. Van den Bosch EW, Van Zwienen CM, Van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma. 2002;53:44–8.

    Article  PubMed  Google Scholar 

  6. Mosheiff R, Khoury A, Weil Y, Liebergall M. First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma. 2004;18:106–11.

    Article  PubMed  Google Scholar 

  7. Acklin YP, Zderic I, Grechenig S, Richards RG, Schmitz P, Gueorguiev B. Are two retrograde 3.5 mm screws superior to one 7.3 mm screw for anterior pelvic ring fixation in bones with low bone mineral density? Bone Jt Res. 2017;6:8–13.

    Article  CAS  Google Scholar 

  8. Becker SC, Holstein JH, Pizanis A, Pohlemann T. Anterior approaches to the pelvic ring. Unfallchirurg. 2013;116:198–204.

    Article  CAS  PubMed  Google Scholar 

  9. Keel MJ, Bastian JD, Büchler L, Siebenrock KA. Anterior approaches to the acetabulum. Unfallchirurg. 2013;116:213–20.

    Article  CAS  PubMed  Google Scholar 

  10. Stoppa R, Petit J, Abourachid H, Henry X, Duclaye C, Monchaux G, Hillebrant JP. Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach. Chirurgie. 1973;99:119–23.

    CAS  PubMed  Google Scholar 

  11. Reiner MA, Bresnahan ER. Laparoscopic total extraperitoneal hernia repair outcomes. JSLS. 2016;20:e2016.00043.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Scheyer M, Zimmermann G. Laparoscopic hernia surgery–status of minimal invasive techniques in a spectrum of surgical indications. Zentralbl Chir. 1997;122:1113–9.

    CAS  PubMed  Google Scholar 

  13. Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.

    Article  PubMed  Google Scholar 

  14. Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy. JSLS. 2013;17:188–93.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Barbaros U, Sümer A, Demirel T, Karakullukçu N, Batman B, Içscan Y, Sarıçam G, Serin K, Loh WL, Dinççağ A, Mercan S. Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma. JSLS. 2010;14:566–70.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Küper MA, Eisner F, Königsrainer A, Glatzle J. Laparoscopic surgery for benign and malign diseases of the digestive system: indications, limitations, and evidence. World J Gastroenterol. 2014;20:4883–91.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schwenk W, Böhm B, Müller JM. Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial. Surg Endosc. 1998;12:1131–6.

    Article  CAS  PubMed  Google Scholar 

  18. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet. 2005;365:1718–26.

    Article  PubMed  Google Scholar 

  19. Schäffler A, König B, Feinauer B, Freude T, Stöckle U, Stuby F. Effects of a pelvic ring injury on earning capacity. Z Orthop Unfall. 2017;155:67–71.

    PubMed  Google Scholar 

  20. Nusser M, Holstiege J, Kaluscha R, Tepohl L, Stuby F, Röderer G, Krischak G. Return to work after fractures of the pelvis and the acetabulum. Z Orthop Unfall. 2015;153:282–8.

    Article  CAS  PubMed  Google Scholar 

  21. Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury. 2015;46:320–6.

    Article  CAS  PubMed  Google Scholar 

  22. Ma K, Luan F, Wang X, Ao Y, Liang Y, Fang Y, Tu C, Yang T, Min J. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics. 2013;36:e1307-e1315.

    Article  Google Scholar 

  23. Shazar N, Eshed I, Ackshota N, Hershkovich O, Khazanov A, Herman A. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma. 2014;28:313–9.

    Article  PubMed  Google Scholar 

  24. Elmadag M, Guzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res. 2014;100:675–80.

    Article  CAS  PubMed  Google Scholar 

  25. Stuby FM, Gonser CE, Baron HC, Stöckle U, Badke A, Ochs BG. Hardware removal after pelvic ring injury. Unfallchirurg. 2012;115:330–8.

    Article  CAS  PubMed  Google Scholar 

  26. Stuby FM, Doebele S, Agarwal Y, Windolf M, Gueorguiev B, Ochs BG. Influence of flexible fixation for open book injury after pelvic trauma—a biomechanical study. Clin Biomech (Bristol Avon). 2014;29:657–63.

    Article  Google Scholar 

Download references

Acknowledgements

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

Author information

Author notes

  1. Markus Alexander Küper and Alexander Trulson contributed equally to this manuscript.

Authors and Affiliations

  1. BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany

    Markus Alexander Küper, Alexander Trulson, Inga Maria Trulson, Christian Minarski, Leonard Grünwald, Christoph Gonser, Christian Bahrs, Ulrich Stöckle & Fabian Maria Stuby

  2. Institute of Clinical Anatomy and Cell Analysis, Eberhard Karls University Tübingen, Tübingen, Germany

    Bernhard Hirt

Authors
  1. Markus Alexander Küper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Trulson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Inga Maria Trulson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Minarski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leonard Grünwald
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Gonser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian Bahrs
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bernhard Hirt
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ulrich Stöckle
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fabian Maria Stuby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Markus Alexander Küper.

Ethics declarations

Conflict of interest

Drs. Markus Alexander Küper, Alexander Trulson, Inga Maria Trulson, Christian Minarksi, Leonard Grünwald, Christoph Gonser, Christian Bahrs, Bernhard Hirt, Ulrich Stöckle and Fabian Maria Stuby have no conflicts of interest or financial ties to disclose.

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 approved the scientific usage of their bodies for teaching and research purposes in their lifetime and the local Ethics committee of the University of Tübingen approved the scientific usage. The patient approved the publication of his case including history of the accident, course of his in-patient treatment and surgical course with images of the operation situs and the postoperative scars as well as the fluoroscopic and radiological images.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Küper, M.A., Trulson, A., Trulson, I.M. et al. EASY (endoscopic approach to the symphysis): a new minimally invasive approach for the plate osteosynthesis of the symphysis and the anterior pelvic ring—a cadaver study and first clinical results. Eur J Trauma Emerg Surg 45, 745–755 (2019). https://doi.org/10.1007/s00068-018-0928-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-018-0928-5

Keywords

Search

Navigation