Robot-Assisted Tailored Neurectomy in Chronic Postherniorrhaphic Inguinal Neuralgia: A Retrospective Analysis

Area of Science:

• Minimally Invasive Surgery
• Pain Management
• Robotic Surgery

Background:

• Chronic postoperative inguinal pain (CPIP) is a challenging complication following hernia repair, often unresponsive to conservative treatments.
• Traditional triple neurectomy (ilioinguinal, iliohypogastric, and genitofemoral nerve resection) presents difficulties with reoperation and nerve identification due to scar tissue.

Purpose of the Study:

• To evaluate the safety and efficacy of robot-assisted tailored neurectomy for managing refractory CPIP.
• To assess the benefits of 3D visualization in precisely resecting affected nerves.

Main Methods:

• A prospective study included ten patients with refractory neuropathic groin pain lasting over six months.
• Patients underwent robot-assisted retroperitoneal neurectomy, with selective nerve resection based on intraoperative findings, following preoperative nerve mapping and imaging.
• Exclusion criteria included severe comorbidities, non-neuropathic pain, or prior triple neurectomy.

Main Results:

• Robot-assisted surgery was completed in all patients with a mean operative time of 60 minutes.
• Mean pain scores significantly decreased from 7.8 to 1.2 at 180 days (P < 0.001).
• 90% of patients discontinued opioid and neuropathic medications, with 80% experiencing transient deafferentation that resolved within six weeks.

Conclusions:

• Robot-assisted tailored neurectomy is a safe and effective treatment for refractory CPIP, providing precise nerve resection and rapid recovery.
• The procedure demonstrates significant pain reduction and high rates of medication cessation, comparable to established success rates.
• This robotic approach surpasses open and laparoscopic techniques through enhanced visualization and adaptability, though larger studies are needed.