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EP721 Obturator nerve injury in pelvic lymphadenectomy – to stitch or not to stitch?
  1. P Kaščák and
  2. M Hlavacik
  1. Ob/Gyn, Faculty Hospital Trencin, Trencin, Slovakia


Introduction/Background In the presented case report we discuss the necessity of immediate treatment of obturator nerve damage in pelvic lymphadenectomy in the light of new surgical procedures in oncogynecology, while considering the abilities and possibilities of the self-repair of damaged peripheral nerves.

Methodology Case report.

Results Between 2011 and 2018 we performed 482 pelvic lymphadenectomy procedures. 470 cases (97.5%) were laparotomies. In 4 cases obturator nerve was injured (0.8%). In 3 patients, the injury occurred during the laparotomy and the nerve was immediately sutured without any subsequent functional deficiency. We present a case of nerve injury during laparoscopic lymphadenectomy where we did not proceed with the immediate treatment. Despite this, the patient suffered no sensitive or functional impairment, either after surgery or 6 months later. Laparoscopic staging was done due to an early stage ovarian carcinoma in a 67-year-old woman. During the right-sided pelvic lymphadenectomy, the obturator nerve was completely transected. Procedure was completed without further complications however immediate endoscopic treatment of the nerve injury was not possible. After some discussion we forgo the idea of immediate laparotomy. Since the patient did not experience any clinical signs of nerve damage, even after postoperative recovery, we definitely abandoned the idea of treating damaged nerve surgically. We have documented this complication on video.

Conclusion Immediate treatment and its technique, delayed suture or conservative procedure for obturator nerve injury can all yield to the favourite functional outcome. In our case, we have abandoned the idea of nerve suture after laparoscopic lymphadenectomy and the patient showed no clinical signs of nerve damage.

Disclosure Nothing to disclose.

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