title: Immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy.
abstract: Intraoperative injury of the obturator nerve may occur in gynecologic oncologic procedures when extensive pelvic side wall dissection is performed. In this case, we report an immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy. A 62-year-old gravida 3, para 3 woman was admitted to our clinic for postmenopausal bleeding. The result of an endometrial biopsy was complex endometrial hyperplasia with atypia, and a robotic-assisted laparoscopic hysterectomy was performed. A frozen section of the specimen revealed grade 1 endometrioid adenocarcinoma with >1/2 myometrial invasion. During the pelvic lymphadenectomy, the left obturator nerve was incompletely transected. The obturator nerve edges were oriented and reapproximated end-to-end with two 6/0 polypropylene sutures. The operation and console times were 244 and 223 minutes, respectively. The final pathologic finding was a stage IB endometrial adenocarcinoma. The number of the obtained lymph nodes was 38. Postoperatively, the patient did not exhibit any clinically apparent loss of adductor function or any other neurologic deficiency. Over 6 months of follow-up, the patient experienced no residual neuropathy or deficit in the left thigh. Robotic-assisted repair of a transected obturator nerve during surgery is feasible, and immediate repair of the damaged nerve may result in no neurologic deficit postoperatively.
authors.affiliation: Ümraniye Education and Research Hospital, İstanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Göçmen
authors.affiliation: Ümraniye Education and Research Hospital, İstanbul, Turkey. Electronic address: fatihroland@hotmail.com.
authors.forename: Fatih
authors.initials: F
authors.lastname: Şanlıkan
mesh_terms: D018269:Carcinoma, Endometrioid / Q000503:physiopathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000295:instrumentation; D008875:Middle Aged; D009776:Obturator Nerve / Q000293:injuries / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome
keywords: Obturator nerve injury; Robotic surgery