Obturator nerve injury during robot-assisted laparoscopic pelvic lymphadenectomy: Literature review and case series

OBJECTIVE: To describe a case series of patients with obturator nerve injury following pelvic lymphadenectomy (PLND) at the study centre, and provide a narrative review of the literature regarding the incidence, management and clinical course of obturator nerve injury after PLND.

METHODS: A literature search was performed using PubMed and Google Scholar, applying the terms 'obturator nerve injury' and 'lymph node dissection', including relevant MeSH terms and synonyms. In addition, all patients with obturator nerve injury following robot-assisted laparoscopic PLND at the study centre between 1 January 2008 and 31 December 2023 were identified. Data regarding type of surgery, surgical repair technique, materials used, and postoperative course were collected. The primary outcome was recovery of motor and sensory function. Secondary outcomes included residual morbidity, the proportion of patients achieving full recovery within 1 year, and the need for additional surgical intervention.

RESULTS: In total, 16 patients with obturator nerve injury following PLND were identified. In most cases, a primary end-to-end epineural anastomosis using 5-0 or 6-0 Prolene sutures was performed. In five patients, a primary anastomosis was not feasible, and nerve grafts or polyglycolic acid/collagen conduits were used. The majority of patients achieved full recovery within 3 months.

CONCLUSION: Obturator nerve injury is a rare complication of PLND. In most cases, primary end-to-end epineural repair can be performed to restore nerve continuity, and this is associated with a favourable clinical course. While most patients recover within 3 months, residual motor deficits may persist in a subset of cases. These findings should be interpreted as descriptive, as comparative evidence regarding surgical techniques and materials remains limited.