NYMC Faculty Publications

Robotic-Assisted Obturator Nerve Repair: A Technical Report

Author Type(s)

Student, Faculty

DOI

10.1227/ons.0000000000001315

Journal Title

Operative Neurosurgery

First Page

571

Last Page

573

Document Type

Article

Publication Date

4-1-2025

Department

Obstetrics and Gynecology

Second Department

Neurosurgery

Keywords

da Vinci, Injury, Laparoscopic, Obturator nerve, Peripheral nerve, Repair, Robotic

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND AND IMPORTANCE: Untreated obturator nerve injury may result in weakness in thigh adduction, decreased medial thigh sensation, and groin pain. A neurosurgeon may be consulted intraoperatively for repair. Although there are reports of obturator nerve injury and repair in the gynecologic surgery literature, there are few reports detailing the specific steps of nerve repair after partial transection and the underlying principles of nerve coaptation, especially in the robotic-assisted setting. CLINICAL PRESENTATION: A partial transection of the right obturator nerve was noted in a patient undergoing total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection using the da Vinci robot. Sutures were placed in the epineurium of the cut nerves to realign the fascicles. A porcine wrap was placed around the coaptation site and covered with fibrin glue. The right lower extremity was passively ranged to ensure no tension was present across the repair site. The patient had loss of right leg adduction after surgery, but she recovered full motor function 5 months after surgery with no numbness or pain. CONCLUSION: The current report describes a repair strategy for partial-thickness obturator nerve injury in the setting of a laparoscopic surgery. Working in a multidisciplinary fashion, the tenets of nerve repair may be applied to robotic-assisted cases of obturator nerve injury, resulting in neurologic recovery.

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