慢性鼠径ヘルニア修復後神経痛に対するロボット支援テーラーメイド神経切除術：後向き解析

Chronic postoperative inguinal pain (CPIP) is a debilitating complication after hernia repair, often resistant to conservative therapy. Traditional triple neurectomy [resection of the ilioinguinal (IIN), iliohypogastric (IHN), and genitofemoral (GFN) nerves] faces challenges such as scar tissue reoperation and nerve identification. This prospective study evaluates the safety and efficacy of robot-assisted tailored neurectomy, leveraging 3D visualization for precision.

Ten consecutive patients (mean age: 46 years; 80% male) with refractory neuropathic groin pain (≥6 months) were enrolled at a university single-center (January-July 2024). Inclusion required preoperative nerve mapping, imaging (CT, MRI, and sonography) to exclude nonneuropathic causes, and failure of conservative measures (nerve blocks and analgesics). Exclusion criteria included ASA class ≥4, nonneuropathic pain, or prior triple neurectomy. Robot-assisted retroperitoneal neurectomy was performed by selectively resecting nerves (IIN, IHN, and GFN) ± mesh removal based on intraoperative findings.

All procedures were completed robotically (mean operative time: 60 minutes, SD: 10.1; no conversions). Mean preoperative pain scores (numeric rating scale) decreased significantly from 7.8 to 1.2 at 180 days (P < 0.001). Opioids and neuropathic medications were discontinued in 90% of patients. Transient deafferentation (hypersensitivity) resolved within 6 weeks in 80% of cases, while 2 patients reported residual but diminishing symptoms. At 10-month follow-up, all patients reported improved daily function with no recurrences. Mean and median hospitalization was 1 day.

Robot-assisted tailored neurectomy is a safe and effective treatment for refractory CPIP, offering precise nerve resection, minimal morbidity, and rapid recovery. The 85% reduction in pain scores and 90% opioid cessation rate align with literature success rates (85-97%). This approach overcomes limitations of open/laparoscopic techniques through enhanced visualization and adaptability. Larger studies are warranted to validate long-term outcomes and cost-effectiveness.