Laparoscopic Acetabular Surgery (LASY) - vision or illusion?

Displaced acetabular fractures usually require open surgical approaches. Aim of this cadaver study was to evaluate a laparoscopic approach to prepare the anterior acetabular column and the quadrilateral plate in analogy to the laparoscopic pelvic lymphadenectomy. The laparoscopic preparation and anatomy is presented and illustrated step by step in a human cadaver followed by a modular plate osteosynthesis of the anterior column involving the quadrilateral plate is performed via a minimally invasive approach using standard laparoscopic instruments. In conclusion we could demonstrate that the laparoscopic preperitoneal preparation of the acetabulum according to the laparoscopic pelvic lymphadenectomy provides more free range for the surgical instruments compared to a previously described total extraperitoneal approach. The development of specific reduction tools and implants is under investigation. Until then, at least the laparoscopic preparation could be introduced in the clinical setting in the near future. TYPE OF STUDY: Technical note - Cadaver study.

Postoperative Outcome of a New Shoulder Orthesis after Arthroscopic Rotator Cuff Repair: a Prospective, Randomized Observational Study. / Postoperative Ergebnisse bei Anwendung einer neuartigen Schulterorthese nach arthroskopischer Rotatorenmanschettenrefixation: eine prospektive, randomisierte Anwendungsbeobachtung.

BACKGROUND: Rotator cuff tears are one of the most frequently treated disorders in arthroscopic surgery. Besides the different surgical options, there are differences in the postoperative aftercare. In this observational study the function, handling and comfort of two different ortheses (ADVAGOshoulder vs. standard abduction orthesis) were compared. PATIENTS AND METHODS: 53 patients with a rotator cuff tear (n = 25 ADVAGOshoulder, n = 28 standard abduction orthesis) were examined and questioned before and after the surgical treatment based on the DASH Score, a modified Constant Score, the function, handling and everyday practicality of their orthesis. RESULTS: The ADVAGOshoulder orthesis showed favorable results concerning the limitations of daily activity, quality of sleep and limitations in movement. The assessment by the patients regarding the contribution to therapeutic success was also more pronounced with ADVAGOshoulder. The standard abduction orthesis was assessed twice as good as the ADVAGOshoulder orthesis in relation to the overall success of treatment. Regarding the DASH questionnaires no significant differences were seen between the two groups. CONCLUSION: Both ortheses proved to be a suitable tool for immobilization of the shoulder after surgery, and contributed to the success of treatment, as assessed by the patients. The ADVAGOshoulder orthesis showed advantages related to limitations in movement and quality of sleep compared to the standard abduction orthesis.

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.

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.

Endoscopic Approach to the Quadrilateral Plate (EAQUAL): a New Endoscopic Approach for Plate Osteosynthesis of the Pelvic Ring and Acetabulum - a Cadaver Study. / Endoscopic Approach to the Quadrilateral Plate (EAQUAL): ein neuer endoskopischer Zugang für die Plattenosteosynthese des Beckenringes und Azetabulums ­ eine anatomische Machbarkeitsstudie.

BACKGROUND: Dislocated pelvic fractures which require surgical repair are usually operated on via open surgery. Approach-related morbidity is reported with a frequency of up to 30%. The aim of this anatomical study was to prove the feasibility of endoscopic visualisation of the relevant anatomical structures in pelvic surgery and to perform completely endoscopic plate osteosynthesis of the acetabulum with available standard laparoscopic instruments. METHOD: In four human cadavers, we established an endoscopic preparation of the complete pelvic ring, from the symphysis to the iliosacral joint, including the quadrilateral plate and the sciatic nerve, and performed endoscopic plate osteosynthesis along the iliopectineal line. RESULTS: The endoscopic preparation of the complete pelvic ring and the quadrilateral plate was demonstrated step-by-step, followed by completely endoscopic plate osteosynthesis along the pelvic brim. Endoscopic, radiographic, and schematic pictures are used to illustrate the technique. CONCLUSION: The completely endoscopic preparation of the pelvic brim and the quadrilateral plate is feasible with available standard laparoscopic instruments. Moreover, plate osteosynthesis could be performed endoscopically. Further research on reduction techniques is necessary when planning to implement this technique into a clinical scenario.

Laparoscopic surgery for benign and malign diseases of the digestive system: indications, limitations, and evidence.

The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient's condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today's indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery.