Laparoscopic repair of obturator nerve transection during pelvic lymphadenectomy

Zhang, Weidong; Jiang, Wenjing; He, Chengqun; Tian, Yuan; Wang, Jiafei

doi:10.1016/j.ijgo.2015.01.002

Cited by 11 publications

(7 citation statements)

References 4 publications

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“…Obturator nerve injury is rare and is most commonly due to gynecologic and urologic procedures 35. In our study, patients had either nerve injury due to lymphadenectomy or radical cystectomy.…”

Section: Discussionmentioning

confidence: 81%

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A systematic review of nerve grafting, end-to-end repair, and nerve transfer for obturator nerve injuries

Garg

Hassan

Ketheeswaran

et al. 2022

Int J Gynecol Cancer

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ObjectiveObturator nerve injury can occur as a complication of gynecologic surgeries, occurring most frequently in patients with endometriosis and genitourinary malignancies. The resulting injury causes paresthesia and major weakness in adduction and atrophy of the adductor group of lower extremity muscles. The objective of this study was to conduct a systematic review and meta-analysis of the effectiveness of end-to-end repair, nerve grafting, and nerve transfer in improving motor function in patients with obturator nerve injury.MethodsPubMed, Cochrane, Medline, and Embase libraries were searched from May 1994 to August 2020 according to the PRISMA guidelines for articles that present functional outcomes after obturator nerve injury in patients treated with nerve grafting, end-to-end repair, or nerve transfer.ResultsA total of 25 patients from 22 studies were included in the study, 15 of whom were treated with end-to-end repair (60%), nine with nerve grafting (36%), and one with nerve transfer (4%). Of the 15 patients with transection data, two had incomplete (13%) and 13 had complete (87%) nerve transections. The patients underwent pelvic lymphadenectomy (n=24) and radical cystectomy (n=1) operations. The mean Medical Research Council (MRC) score was 2.95±1.7 immediately after treatment and 4.77±0.6 at the final follow-up. All patients achieved good outcomes (MRC ≥3) at the final follow-up. The mean MRC score for end-to-end repair (n=15), nerve grafting (n=9), and nerve transfer (n=1) was 4.8±0.6, 4.7±0.8, and 5, respectively. Patients with end-to-end repair had higher immediate post-operative strength than those treated with nerve grafting (p=0.03) and tended to achieve full functional recovery after shorter periods of time (rho=−0.65, p=0.049). Other parameters did not correlate with MRC.ConclusionEnd-to-end repair, nerve grafting, and nerve transfer are equally effective in restoring function in patients with obturator nerve injury. However, patients treated with end-to-end repair had higher immediate post-operative strength than those treated with nerve grafting.

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Section: Discussionmentioning

confidence: 81%

“…The 149 articles were screened by titles and abstracts and then full-text articles were reviewed. The final selection of 22 articles fit the inclusion criteria and contained a total of 25 patients from 2004 to 2019 1 6 17–36…”

Section: Resultsmentioning

confidence: 99%

A systematic review of nerve grafting, end-to-end repair, and nerve transfer for obturator nerve injuries

Garg

Hassan

Ketheeswaran

et al. 2022

Int J Gynecol Cancer

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“…Sectioning of the obturator nerve at the time of pelvic lymphadenectomy is a complication that has been reported in some series 15 , 16 . We observed sectioning of the obturator nerve in one robotic surgery and in two traditional laparoscopic surgeries.…”

Section: Discussionmentioning

confidence: 97%

Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs

Silva¹,

Carvalho²,

Antón³

et al. 2018

Clinics

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OBJECTIVE:The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach.METHODS:In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs.RESULTS:The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery.CONCLUSIONS:Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.

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“…When literature was assessed, it was seen that Menderes et al [ 7 ], Zhao et al [ 8 ] and Göçmen et al [ 9 ] reported nerve repair by laparoscopic epineural end-to-end anastomosis after recognition of intraoperative nerve transection. All authors reported complete recovery at the end of month 6.…”

Section: Discussionmentioning

confidence: 99%

Concurrent primary repair of obturator nerve transection during pelvic lymphadenectomy procedure via laparoscopical approach

Andan

Bakır

Sen

et al. 2018

International Journal of Surgery Case Reports

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Laparoscopic repair of obturator nerve transection during pelvic lymphadenectomy

Cited by 11 publications

References 4 publications

A systematic review of nerve grafting, end-to-end repair, and nerve transfer for obturator nerve injuries

A systematic review of nerve grafting, end-to-end repair, and nerve transfer for obturator nerve injuries

Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs

Concurrent primary repair of obturator nerve transection during pelvic lymphadenectomy procedure via laparoscopical approach

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