Objectives For early-stage endometrial cancer, laparoscopic surgery is well established in many countries. In Japan, the procedure is covered by insurance from 2014. Since then, laparoscopic surgeries for gynecological cancers have been performed by not only gynecolo-oncologists but also laparoscopic qualified gynecologists. To review the safety of our cases, this IRB-approved study was performed.

Methods Operative cases of endometrial cancer were reviewed retrospectively.

Results Out of 94 stage I endometrial cancer cases who underwent laparoscopic surgery, total laparoscopic modified radical hysterectomy + laparoscopic pelvic lymphadenectomy was performed for 22 patients. Median operative duration was 238 minutes, and median blood loss was 100mL. We experienced two cases of obturator nerve complete transection. Both of the surgeons were laparoscopic board certificated. In both cases, right obturator nerve was cut near to the branch of internal iliac vein. Surgical video can be revisited for one patient. The nerve covered with lymphatic tissue was dragged out medially under the internal iliac branch, and cut misinterpreted as a lymphatic trunk. For both, although nerve correction was done during surgery by suturing, rehabilitation was necessary. For open surgery, we have never experienced obturator nerve injury during the pelvic lymphadenectomy in the same period.

Conclusions Obturator nerve injury during pelvic surgery is possibly frequent in laparoscopic surgery.