Femoral nerve injury after gynecologic laparoscopy

Femoral nerve injury after gynecologic laparoscopy is reported very rarely, and usually only as a consequence of lithotomy position. A 36-year-old woman underwent left partial laparoscopic ovariectomy. A primary Hasson trocar was inserted through infraumbilical incision; 2 secondary trocars were placed in right hypocondrium and left iliac fossa, just cranially to the inguinal fold. After operation, the patient showed irreversible femoral neuropathy, with left thigh weakness and allodynic paresthesias, from the site of the left trocar insertion to the anteromedial aspect of the thigh and medial aspect of the leg and foot. To our knowledge, this is the first report of femoral nerve injury caused by trocar insertion. Peritoneal adhesions and inadequate pneumoperitoneum may have increased the risk of nerve injury. Physicians should be aware of the possibility of this complication, and should avoid too caudal a trocar insertion in iliac fossa.