An imaging study on establishing radial volar portals using the Kiss-in method in wrist arthroscopy.

PURPOSE: The feasibility and safety of the Kiss-in method for VRMC and VRRC portals in wrist arthroscopy were evaluated using 3D CT reconstructions in 64 adults (32M/32F) to quantify anatomical parameters and identify gender-specific risks.

METHODS

Mimics software generated 3D models of radius, ulna, carpal bones, radial artery (RA), median nerve (MN), and flexor carpi radialis (FCR). A 3.5 mm virtual trocar was inserted via the Kiss-in method; an axis-radius-aligned coordinate system enabled precise measurement of dTRA, dTMN, dTF, dTP, aTTR, aSTR, aNAT, and aNFT. A "risky zone" (≤0 mm from RA/MN) was defined and analyzed.

RESULTS

No statistically significant differences were found between most parameters of the two portals, except for dTP and dTF. The data for dTF, dTP, aTTR in the VRMC portal, and aSTR in the VRRC portal showed statistically significant differences between genders. Female dTP values at both joints were less than the trocar's length of 45 mm. Male dTP values in the VRRC portal exceeded 45 mm in 22 cases (68.75%), and in the VRMC portal, 10 cases (31.25%). The frequency of the "risky zone" was significantly higher in the VRRC portals.

CONCLUSIONS

This imaging simulation study supports the theoretical feasibility of the Kiss-in method for establishing radial volar portals. The simulation results suggest potential safety benefits for the VRRC portal and indicate that the standard trocar length may be more adequate for female patients in this cohort. The determination of aTTR and aSTR has guiding significance for the practical application of the Kiss-in method.