Robotic-Assisted Obturator Nerve Repair: A Technical Report

Area of Science:

• Minimally Invasive Surgery
• Neuro-oncology
• Surgical Neurology

Background:

• Obturator nerve injury can cause thigh adduction weakness, sensory loss, and groin pain.
• Intraoperative neurosurgeon consultation may be needed for nerve repair.
• Limited reports exist on robotic-assisted obturator nerve repair after partial transection.

Purpose of the Study:

• To describe a specific nerve repair strategy for partial obturator nerve transection during robotic-assisted laparoscopic surgery.
• To illustrate the application of nerve coaptation principles in a robotic surgical context.

Main Methods:

• Partial obturator nerve transection identified during robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection.
• Epineurial sutures used for fascicle realignment.
• Porcine submucosa extracellular matrix (ECM) wrap and fibrin glue applied to the coaptation site.
• Post-repair passive range of motion to ensure no tension on the repair site.

Main Results:

• Patient experienced temporary loss of right leg adduction post-surgery.
• Full motor function recovery in the right leg occurred at 5 months post-surgery.
• No residual numbness or pain reported by the patient.

Conclusions:

• A successful repair strategy for partial obturator nerve injury in robotic-assisted laparoscopic surgery is presented.
• Fundamental nerve repair principles are applicable to robotic surgery.
• Multidisciplinary approach led to successful neurologic recovery.