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

Yong Kuei Lim^1,

¹Department of Gynaecologic Oncology, KK Women’s & Children’s Hospital, Singapore

Cite this paper

Yong Kuei Lim. Near Total Transection of the Obturator Nerve and Primary Repair during Laparoscopic Radical Hysterectomy for Cervical Cancer. American Journal of Medical Case Reports. 2017; 5(7):174-176. doi: 10.12691/AJMCR-5-7-1

Abstract

Background: Obturator nerve injury is a rare complication and it may occur during pelvic cancer surgery especially during pelvic lymphadenectomy. The injury may cause paraesthesia, sensory loss or pain in the medial thigh which may extend down to the knee. It can also cause weakness in adduction with gait disturbance, medial thigh wasting and possible medico-legal consequences. Case Report: The patient is a 57 year old lady who was found to have an early cervical cancer. MRI abdomen and pelvis was negative for regional lymphadenopathy or distant metastases hence clinically she had a Stage IB1 SCC of cervix. She underwent a Total Laparoscopic Wertheim's Radical Hysterectomy BSO Bilateral Pelvic Lymphadenectomy in February 2015. During the pelvic lymphadenectomy, the left obturator nerve was inadvertently damaged and partially transected by the Harmonic scalpel. The nerve was reconstituted by interrupted 5-O vicryl suture to the epineural layer of the nerve. Post operatively, the patient experienced weakness of the adductor muscles (3/5) but negligible sensory loss. Four months after intensive physiotherapy, the motor deficit was markedly reduced and her gait was normal. There was no sensory loss. Final histology revealed that the surgical margins was clear and 0/41 pelvic lymph nodes were negative. Hence she did not need any adjuvant therapy. Conclusion: Obturator nerve injury is a rare complication with a significant clinical impact if unrecognised. In uncomplicated cases, laparoscopic route of repair is feasible and safe and an immediate repair of the nerve is preferable.

Keywords

cervical cancer, obturator nerve injury, laparoscopy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Ricciardi E, Jakimovska M, Maniglio P, Schimberni M, Frega A, Kobal B, Moscarini M. Laparoscopic injury of the obturator nerve during fertility-sparing procedure for cervical cancer. World J Surg Oncol. 2012 Aug 30; 10: 177.
[2]	Vasilev SA. Obturator nerve injury: a review of management options. Gynecol Oncol. 1994 May; 53(2): 152-5.
[3]	Tipton JS. Obturator neuropathy. Curr Rev Musculoskelet Med. 2008 Dec; 1(3-4): 234-7.
[4]	Harma M, Sel G, Açıkgöz B, Harma MI. Successful obturator nerve repairing: Intraoperative sural nerve graft harvesting in endometrium cancer patient. Int J Surg Case Rep. 2014; 5(6): 345-6.
[5]	Dias AR, Silva e Silva A, Carvalho JP, Baracat EC, Favero G. Correction of iatrogenic injury of the obturator nerve during pelvic laparoscopic lymphadenectomy by the use of sural nerve grafts. Gynecol Oncol Rep. 2014 Dec 6; 10: 16-8.
[6]	Nezhat FR, Chang-Jackson SC, Acholonu UC Jr, Vetere PF. Robotic-assisted laparoscopic transection and repair of an obturator nerve during pelvic lymphadenectomy for endometrial cancer. Obstet Gynecol. 2012 Feb; 119(2 Pt 2): 462-4.
[7]	Menderes G, Vilardo N, Schwab CL, Azodi M.Incidental injury and repair of obturator nerve during laparoscopic pelvic lymphadenectomy. Gynecol Oncol. 2016 Jul; 142(1): 208.
[8]	Göçmen A, Şanlıkan F. Immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy. J Minim Invasive Gynecol. 2015 Feb; 22(2): 302-4.