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. 2017 Dec 11;7(1):e23-e27.
doi: 10.1016/j.eats.2017.08.045. eCollection 2018 Jan.

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture

Justin W Arner  1 , Marcio Albers  1 , Brian S Zuckerbraun  2 , Craig S Mauro  3
Affiliations

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture

Justin W Arner et al. Arthrosc Tech. .

Abstract

Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, more commonly used in the treatment of osteitis pubis. An emerging option is minimally invasive laparoscopic fixation using knotless anchors with a tape suture in a crisscross configuration. This possibly allows more physiological movement of the pubic symphysis in a less invasive manner. A detailed technical description and discussion of the technique are provided.

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Figures

Fig 1
Fig 1
Radiograph showing a flamingo view of the discussed patient standing on a step with his right leg and left leg suspended. The image shows >2 mm displacement of the pubic symphysis, indicating instability.
Fig 2
Fig 2
Radiograph showing a flamingo view of the discussed patient standing on a step with his left leg and right leg suspended. The image shows >2 mm displacement of the pubic symphysis, indicating instability.
Fig 3
Fig 3
Laparoscopic view of the space of Retzius showing the bilateral dissection of the pubic bone leaving the symphysis joint preserved: symphysis (white *), right pubic bone (black *), left pubic bone (black +).
Fig 4
Fig 4
Fluoroscopic view showing appropriate placement of the right superior anchor approximately 10 mm from and 90° to the symphysis. This anchor is placed through the standard right-sided laparoscopic port.
Fig 5
Fig 5
Fluoroscopic view showing appropriate placement of the left posterior anchor approximately 10 mm from and 90° to the symphysis. This anchor is placed through the percutaneous suprapubic portal.
Fig 6
Fig 6
Laparoscopic view of the right superior anchor (+), right posterior anchor (black *), and pubic symphysis (white *).
Fig 7
Fig 7
Laparoscopic view of the left posterior anchor (▴), right superior anchor (+), right posterior anchor (black *), and pubic symphysis (white *).
Fig 8
Fig 8
Laparoscopic view of the final construct: superior left anchor (▪), posterior left anchor (▴), superior right anchor (+), posterior left anchor (black *), and pubic symphysis (white *).
Fig 9
Fig 9
Final radiograph showing appropriate anchor placement approximately 10 mm from the symphysis.
See this image and copyright information in PMC

References

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