Endoscopically Assisted Periacetabular Osteotomy for Treatment of Hip Dysplasia: The Orthopaedic Total Extraperitoneal Approach

The orthopaedic total extraperitoneal (O‐TEP) approach is an endoscopic technique that has recently emerged as an option, particularly for the surgical management of pelvic and acetabular fractures. Unlike conventional orthopaedic endoscopic procedures, O‐TEP was developed by adapting the laparoscopic totally extraperitoneal approach, commonly used for inguinal hernia repair, to orthopaedic surgery. In technically demanding procedures such as periacetabular osteotomy (PAO), minimizing soft‐tissue dissection and directly visualizing critical neurovascular structures are essential. Owing to its minimally invasive design, the O‐TEP PAO technique is intended to limit soft‐tissue dissection while enabling direct visualization of key vascular and neural structures at risk. This Technical Note provides a step‐by‐step description of O‐TEP PAO technique for acetabular dysplasia and discusses its feasibility, potential advantages, and key limitations in the context of the current literature on endoscopy‐assisted PAO techniques.