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. 2020 Jul 6;33(4):550-553.
doi: 10.1080/08998280.2020.1776813.

Carbon dioxide gas endoscopy of the deep gluteal space

Hal David Martin  1 , Munif Hatem  1 , Juan Gómez-Hoyos  1   2 , Luis Pérez-Carro  3 , Anthony N Khoury  1
Affiliations

Carbon dioxide gas endoscopy of the deep gluteal space

Hal David Martin et al. Proc (Bayl Univ Med Cent). .

Abstract

The treatment of hip and pelvic pain associated with abnormalities of the deep gluteal space has evolved and increasingly involves endoscopic techniques with a saline expansion medium. This investigation presents a surgical technique utilizing carbon dioxide as the insufflation medium for deep gluteal space endoscopy in 17 cadaveric hips. This technique was successful in 94% (16/17) of the hips, allowing for visualization of the sciatic nerve, posterior femoral cutaneous nerve, pudendal nerve, branch of the inferior gluteal artery crossing the sciatic nerve, piriformis muscle, hamstring tendon origin, and lesser trochanter. Our experience suggests that gas expansion presents several advantages over fluid expansion.

Keywords: Carbon dioxide gas endoscopy; deep gluteal space; ischiofemoral impingement; sciatic nerve release.

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Figures

Figure 1.
Figure 1.
Portals to access the right deep gluteal space. AL indicates anterolateral; PA, posterior auxiliary; PL, posterolateral; DA, distal auxiliary.
Figure 2.
Figure 2.
Endoscopic view with CO2 gas expansion in the right hip. (a) Sciatic nerve (SN) visualization posterior to the obturator internus/gemelli (external rotators). The black arrow indicates the posterior cutaneous nerve. (b) Light blue suture at a branch of the inferior gluteal artery. (c) Distal view of the SN coursing distally to the thigh. (d) Hamstring tendon (HT) origin at the ischial tuberosity exposed by moving the SN medially with a laparoscopic instrument.
Figure 3.
Figure 3.
Kocher-Langenbeck exposure to the right deep gluteal space after the endoscopic procedure to confirm the marked structures. The black arrow indicates the sciatic nerve.
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