Nerve injury associated with pelvic surgery
- Jermaine E Gray, MD
Jermaine E Gray, MD
- Assistant Professor of Obstetrics and Gynecology
- University of Mississippi Medical Center
- Section Editors
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
- Hilary Sanfey, MD
Hilary Sanfey, MD
- Section Editor — General Surgical Principles
- Section Editor — Quality and Safety
- Professor of Surgery
- SIU School of Medicine
Neural injury can be an unexpected and distressing complication of an otherwise successful operation. Pain, paresthesias, loss of sensation, and weakness are the most common symptoms.
The most common causes of nerve injury during pelvic surgery are:
- Transection from incision, trocar insertion, or thermal injury from electrosurgical devices
- Entrapment from ligation for control of bleeding, tissue reapproximation (eg, closure of retroperitoneum), or reconstructive pelvic surgery (eg, vaginal or bladder suspension procedures)
- Compression or stretching of the nerve from patient positioning, retractors, clamps, or hematoma
The degree of neural injury determines whether symptoms will be reversible or permanent. The typical manifestations are motor weakness and sensory deficit in the area of the involved nerve. However, transection or ligation injuries can result in pain.
This topic will focus upon injury to abdominal and pelvic nerves. The clinical presentation and diagnosis of peripheral nerve injuries are discussed in detail separately. (See "Overview of lower extremity peripheral nerve syndromes" and "Overview of upper extremity peripheral nerve syndromes".)
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- TRANSECTION INJURIES FROM INCISIONS
- Longitudinal incisions
- Transverse incisions
- ENTRAPMENT INJURIES
- COMPRESSION INJURIES
- SELECTED NEUROPATHIES
- Iliohypogastric and ilioinguinal nerves
- Femoral nerve
- Genitofemoral and lateral femoral cutaneous nerves
- Obturator nerve
- Peroneal nerve
- Pudendal nerve
- Isolated nerve roots S1-S4
- Nervi erigentes
- Brachial plexus
- PREVENTION OF NERVE INJURY
- Avoid patient malposition
- Avoid prolonged lithotomy position
- Avoid extreme Trendelenburg position
- Attention to the surgical incision
- Attention to retractors
- SUMMARY AND RECOMMENDATIONS