Management of obturator nevre injury during pelvic lymph node dissection

Özet

Objective: Obturator nerve injuries may be seen during pelvic lymph node dissection in oncological surgeryand although not common it is an important complication. According to the shape and location of the injury,tingling and loss of sensation may develop on the inner surface of the leg, together with loss of motor function of the adductor muscles. In this study an evaluation was made of these complications encountered in ourclinic and the management strategies applied to these patients.Material and methods: The data were retrospectively reviewed of 843 patients who underwent open radicalretropubic prostatectomy between January 2002 and May 2016. To confirm obturator nerve palsy, electrophysiological investigation (ENG-EMG) was performed immediately postoperatively and 3 weeks later.Results: A total of 6 obturator nerve injuries occurred during pelvic lymphadenectomy (0.7%). Reapproximation end to end with sutures was applied in 3 case and sural nerve graft in 1. In the other 2 patients, justclips were placed and these were removed early during the operation. After the treatment period, neurotropicmedications or physiotherapy were given in some cases according to the neurological examinations.Conclusion: Obturator nerve injury can be prevented by having a comprehensive knowledge of pelvic anatomy, and avoiding the use of electrocautery during lymph node dissection. The repair should be performedas soon as possible, with a tension-free reapproximation of the ends, using electrophysiological tests witha multidisciplinary approach and benefit should be taken from physiotherapy and medical treatment whenneeded