Management of obturator nevre injury during pelvic lymph node dissection.

Yıkılmaz TN, Öztürk E, Hamidi N, Başar H, Yaman Ö, Yaman O
Turkish journal of urology · 2019 · doi:10.5152/tud.2018.26235 · PMID:29975634 · PMC7595029
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This retrospective study of 843 prostatectomy patients evaluated the incidence, management, and outcomes of rare obturator nerve injuries occurring during pelvic lymph node dissection.

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This retrospective study evaluated the incidence and management of obturator nerve injuries occurring during pelvic lymph node dissection in 843 patients undergoing open radical retropubic prostatectomy. The researchers identified six cases of nerve palsy, confirmed by electrophysiological investigations, and treated them using surgical repair techniques such as end-to-end suturing or nerve grafting, alongside postoperative physiotherapy and medication. The authors concluded that preventing these injuries requires detailed anatomical knowledge and avoiding electrocautery near the nerve, while immediate tension-free repair yields better outcomes. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

ObjectiveObturator nerve injuries may be seen during pelvic lymph node dissection in oncological surgery and although not common it is an important complication. According to the shape and location of the injury, tingling and loss of sensation may develop on the inner surface of the leg, together with loss of motor function of the adductor muscles. In this study an evaluation was made of these complications encountered in our clinic and the management strategies applied to these patients.Material and methodsThe data were retrospectively reviewed of 843 patients who underwent open radical retropubic prostatectomy between January 2002 and May 2016. To confirm obturator nerve palsy, electrophysiological investigation (ENG-EMG) was performed immediately postoperatively and 3 weeks later.ResultsA total of 6 obturator nerve injuries occurred during pelvic lymphadenectomy (0.7%). Reapproximation end to end with sutures was applied in 3 case and sural nerve graft in 1. In the other 2 patients, just clips were placed and these were removed early during the operation. After the treatment period, neurotropic medications or physiotherapy were given in some cases according to the neurological examinations.ConclusionObturator nerve injury can be prevented by having a comprehensive knowledge of pelvic anatomy, and avoiding the use of electrocautery during lymph node dissection. The repair should be performed as soon as possible, with a tension-free reapproximation of the ends, using electrophysiological tests with a multidisciplinary approach and benefit should be taken from physiotherapy and medical treatment when needed.
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Abstract

Objective: Obturator nerve injuries may be seen during pelvic lymph node dissection in oncological surgery and although not common it is an important complication. According to the shape and location of the injury, tingling and loss of sensation may develop on the inner surface of the leg, together with loss of motor function of the adductor muscles. In this study an evaluation was made of these complications encountered in our clinic and the management strategies applied to these patients.

Material and methods

The data were retrospectively reviewed of 843 patients who underwent open radical retropubic prostatectomy between January 2002 and May 2016. To confirm obturator nerve palsy, electrophysiological investigation (ENG-EMG) was performed immediately postoperatively and 3 weeks later.

Results

A total of 6 obturator nerve injuries occurred during pelvic lymphadenectomy (0.7%). Reapproximation end to end with sutures was applied in 3 case and sural nerve graft in 1. In the other 2 patients, just clips were placed and these were removed early during the operation. After the treatment period, neurotropic medications or physiotherapy were given in some cases according to the neurological examinations.

Conclusion

Obturator nerve injury can be prevented by having a comprehensive knowledge of pelvic anatomy, and avoiding the use of electrocautery during lymph node dissection. The repair should be performed as soon as possible, with a tension-free reapproximation of the ends, using electrophysiological tests with a multidisciplinary approach and benefit should be taken from physiotherapy and medical treatment when needed. Cite this article as: Yıkılmaz TN, Öztürk E, Hamidi N, Başar H, Yaman Ö. Management of obturator nevre injury during pelvic lymph node dissection. Turk J Urol 2019; 45(Supp. 1): S26-S29.

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