Laparoscopic injury of the obturator nerve during fertility-sparing procedure for cervical cancer

Abstract

BackgroundIntraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible.Case presentationA 28-year-old woman with stage IB cervical cancer underwent fertility–sparing surgery, including conization and bilateral pelvic lymphadenectomy. The left obturator nerve was damaged intraoperatively during pelvic dissection.ConclusionImmediate laparoscopic repair was successful and there was no functional deficit in the left thigh for six months postoperatively.

Topographical relationships between the obturator nerve, artery, and vein in the lateral pelvic wall

“…The ON is an important landmark that is retracted during pelvic lymph node dissection [10][11][12] and is therefore prone to injury. The ON is at particular risk of injury during pelvic lymphadenectomy in gynecologic [12,13] or urologic [10,14,15] surgery.…”

“…The ON is at particular risk of injury during pelvic lymphadenectomy in gynecologic [12,13] or urologic [10,14,15] surgery. Vessels that are closely contiguous with the ON may be also be injured during such procedures.…”

Near Total Transection of the Obturator Nerve and Primary Repair during Laparoscopic Radical Hysterectomy for Cervical Cancer

“…Epineural end-to-end tension free coaptation is considered the most efficient method to restore anatomy and function of the nerve using 5-O or 6-O sutures. [1,6] Alternatively, sural nerve graft interposition has been described as another method to repair especially in a situation where end to end alignment cannot be achieved or when the area of damage is too large to allow end to end anastomosis. [4,5] The microsurgical repair can be achieved usually via laparotomy but there are recent reports of laparoscopic or robotic primary repair with good outcomes.…”

“…[4,5] The microsurgical repair can be achieved usually via laparotomy but there are recent reports of laparoscopic or robotic primary repair with good outcomes. [1,6,7,8] The advantage for laparoscopic repair is the magnification which allows for precise repair, provided the attending surgeon can perform laparoscopic suturing.…”

“…The injury usually results from sectioning, stretching or crushing of the nerve. [1] The obturator nerve originates from L2-L4 and is essentially a motor nerve that innervates the medial thigh adductor muscles such as the gracilis, adductor longus brevis and magnus, pectineus and obturator externus as well as an articular branch to the knee joint. [2,3] It also gives rise to some sensory fibres to the medial thigh.…”