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| Assoc. Prof. Dr. Le Nghi Thanh Nhan, Deputy Director of Hue University of Medicine and Pharmacy Hospital |
Speaking about the complexity of the modified Stoppa approach and personalized 3D printing technology, Assoc. Prof. Dr. Le Nghi Thanh Nhan, Deputy Director of Hue University of Medicine and Pharmacy Hospital, Head of the Department of Orthopedic Trauma – Thoracic Surgery, and Chief Surgeon, explained: The modified Stoppa approach originated from the surgical techniques of Rives et al. and Stoppa et al., which were applied in inguinal hernia repair using an intrapelvic approach. Previously, fractures of the anterior wall and quadrilateral surface of the acetabulum were typically treated using Letournel’s ilioinguinal approach. This approach required opening the inguinal canal to expose the spermatic cord, dissecting the external iliac vessels, and the femoral nerve - meaning trauma surgeons had to be proficient in both groin surgery and vascular surgery from other specialties, or work in collaboration with them. As a result, the surgery was highly complex and could only be performed in specialized centers. The modified Stoppa approach, however, allows exposure of the anterior wall and quadrilateral surface of the acetabulum via a midline incision, without the need to expose high-risk structures such as the inguinal canal, iliac vessels, or femoral nerve. This shortens surgical time, reduces the risk of complications, and - most notably - gives the surgeon a clear view of the quadrilateral surface, which was the most difficult area to access using traditional approaches.
Acetabular fractures of the hip joint involve a deep structure covered by muscles and consisting of multiple components, making it difficult to accurately assess the injury using conventional X-rays. The advent of CT scans and 3D reconstruction has enabled surgeons to precisely visualize the injury, fracture pattern, fracture lines, and displacement, thereby allowing accurate selection of the surgical approach and appropriate fixation devices. A new advancement in 3D technology is the application of 3D printing to create accurate, life-sized models based on each patient’s anatomy. This helps surgeons gain a detailed understanding of the fracture pattern, rehearse the surgery on the model to plan reduction techniques, select and shape plates to fit the fracture pattern, determine fixation points, and choose screws with the appropriate length and type - making the surgical plan highly personalized for each case.
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| Assoc. Prof. Dr. Le Nghi Thanh Nhan (first from the left) and the surgical team |
Therefore, the application of 3D printing technology allows for precise understanding of the injury and thorough preoperative preparation, making the surgical procedure smoother and helping to avoid unfortunate errors in choosing the surgical approach or technique. The modified Stoppa approach provides better and easier access and can be applied in many facilities without the need for extensive multidisciplinary collaboration.
Is this the first time Hue University of Medicine and Pharmacy Hospital performed this technique, professor? As the person directly overseeing and carrying out this complex surgery, how do you feel?
That’s correct! This is the first time Hue University of Medicine and Pharmacy Hospital performed this technique. Nationwide, a few hospitals have also applied this surgical approach to treat acetabular fractures, and it has received strong support due to the advantages mentioned above.
Performing this technique for the first time required thorough preparation for every possible scenario. In the worst-case situation - such as complications involving injury to the iliac vessels or femoral nerve - immediate intervention is necessary to prevent life-threatening risks to the patient. We have had over 10 years of experience using Letournel’s complex ilioinguinal approach, so adopting this approach as an extension of the ilioinguinal route, while avoiding dissection of neurovascular structures and the inguinal canal, was a logical step. For this reason, implementing this new surgical approach did not pose excessive difficulty for us.
To perform the modified Stoppa approach and personalized 3D printing technology, could you share the professional qualifications a surgeon needs and what meticulous preparations must be done before entering the operating room?
I believe trauma-orthopedic surgeons can all perform this technique, but the crucial point is thorough preparation: they must have a solid grasp of pelvic applied anatomy, especially the structures related to this approach; be proficient in basic dissection techniques; and know how to manage complications if they occur. With the support of 3D printing technology, surgeons can visualize the reduction plan, choose plate positions, and decide the number, length, and direction of screws, which makes the operation much more straightforward.
In addition, it is best to have a team of surgeons who thoroughly understand the stages of the surgery and coordinate to support each other, which will achieve higher effectiveness. If the surgeon has extensive experience in pelvic surgery and is familiar with various pelvic approaches, it will be much easier to apply this surgical method.
Following the success of this surgery, how will the hospital continue to implement and promote this technique to bring effective treatment to similar cases, professor?
In the near future, we will standardize and learn from this surgery to develop a strict process, including specific preoperative planning, 3D modeling, and the surgical steps protocol, so that we can disseminate and train this surgical technique to other medical facilities in the region, just as we previously transferred the pelvic-inguinal surgical technique to several hospitals in the Central region. We aim to establish a unit applying 3D printing technology in the field of orthopedic trauma, especially for complex intra-articular fractures, to achieve better, more precise surgical outcomes and reduce the risk of complications. In particular, in orthopedics, we have also applied this technology in hip replacement surgeries and the correction of congenital or acquired limb deformities during axis realignment.
The Department of Orthopedic Trauma and Thoracic Surgery at the hospital has also had several reports on the application of 3D printing technology in the fabrication of drilling guide instruments for the acetabulum in hip replacement surgery to ensure accuracy and reduce the risk of postoperative dislocation, as well as in surgeries for tibial plateau fixation, distal radius fractures, and more. These findings have been presented at national specialized conferences such as the 2023 Vietnam Orthopedic Trauma Science Conference, the 2024 Vietnam Arthroscopy and Joint Replacement Conference, and the 2024 Vietnam Surgery Conference.
Thank you very much, professor!