Diseases of the Colon & Rectum

, Volume 38, Issue 10, pp 1115–1118 | Cite as

Femoral neuropathy secondary to the use of a self-retaining retractor

Report of three cases and review of the literature
  • Robert C. Brasch
  • Anthony J. Bufo
  • Paul F. Kreienberg
  • Garner P. Johnson
Case Reports


PURPOSE: Three recent cases of femoral neuropathy at our institution following colorectal surgery have been ascribed to the use of the self-retaining BookwalterTM retractor. The pathophysiology of neural injury includes compression, stretch, transection, ligation, iliopsoas hematoma, ischemia, and cement encapsulation. The Alm of this study is to provide a comprehensive review of femoral nerve anatomy and mechanism of retractor injury. METHODS: The relationship of the femoral nerve to the lateral blade of the BookwaiterTM retractor was evaluated during colorectal surgery and in cadaveric dissections. RESULTS: The lateral blade of the self-retaining retractor was observed to either compress or impinge the intrapelvic portion of the femoral nerve. CONCLUSION: The incidence of postoperative femoral neuropathy is likely underestimated because a majority of cases are self-limited. This debilitating iatrogenic injury can be prevented with a thorough understanding of femoral nerve anatomy and careful placement of self-retaining retractor blades.

Key words

BookwalterTM Retractor Femoral neuropathy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rosenblum J, Schwartz G, Bendler E. Femoral neuropathy—a neurological complication of hysterectomy. JAMA 1966;195:115–20.Google Scholar
  2. 2.
    Gumpertz K. Narkoselahmung des nervos cauralis. Dtsch Med Wochenschr 1896;22:504–5.Google Scholar
  3. 3.
    Pozzati E, Poppi M, Galassi E. Femoral nerve lesion secondary to inguinal herniorrhaphy. Int Surg 1982;67:85–6.Google Scholar
  4. 4.
    Pontin AR, Donaldson RA, Jacobson JE. Femoral neuropathy and renal transplantation. S Afr Med J 1978;53:376–8.Google Scholar
  5. 5.
    Boontje H, Haaxama R. Femoral neuropathy as a complication of aortic surgery. J Cardiovasc Surg (Torino) 1987;28:286–9.Google Scholar
  6. 6.
    Vosborg LF, Finn WF. Femoral nerve impairment subsequent to hysterectomy. Am J Obstet Gynecol 1961;82:931–6.Google Scholar
  7. 7.
    Johnson DA, Montgomery RR. Femoral neuropathy in abdominopelvic surgery. Med Ann DC 1958;27:513–4.Google Scholar
  8. 8.
    McDaniel GC, Kirkley WH, Gilbert JC. Femoral nerve injury associated with the pfannenstiel incision and abdominal retractors. Am J Obstet Gynecol 1963;87:381–5.Google Scholar
  9. 9.
    Hopper CL, Baker JB. Bilateral femoral neuropathy complicating vaginal hysterectomy. Obstet Gynecol 1968;4:543–7.Google Scholar
  10. 10.
    Sinclair RH, Pratt JH. Femoral neuropathy after pelvic operation. Gynecology 1971;112:404–7.Google Scholar
  11. 11.
    Georgy FM. Femoral neuropathy following abdominal hysterectomy. Am J Obstet Gynecol 1975;123:819–2.Google Scholar
  12. 12.
    Kvist-Poulsen H, Borel J. Iatrogenic femoral neuropathy subsequent to abdominal hysterectomy: incidence and prevention. Obstet Gynecol 1981;4:516–20.Google Scholar
  13. 13.
    Katirji MB, Lanska DJ. Femoral mononeuropathy after radical prostatectomy. Urology 1990;36:539–40.Google Scholar
  14. 14.
    Wasielewski RC, Crossett LS, Aubash HE. Neural and vascular injury in total hip arthroplasty. Orthop Clin North Am 1992;23:219–35.Google Scholar
  15. 15.
    Goldman JA, Feldberg D, Dicker D. Femoral neuropathy subsequent to abdominal hysterectomy: a comprehensive study. Eur J Obstet Gynecol Reprod Biol 1985;20:385–92.Google Scholar
  16. 16.
    Denny-Brown D, Brenner C. Lesion in peripheral nerve resulting from compression by spring clip. Arch Neurol Psychiatry 1944;52:1–19.Google Scholar
  17. 17.
    Vaziri ND, Barnes J, Khosrow M, Richard E, Stanley RM. Compression neuropathy subsequent to renal transplantation. Urology 1976;7:145–7.Google Scholar
  18. 18.
    Kenrick MM. Femoral nerve injuries following pelvic surgery: diagnosis and treatment. South Med J 1963;53:152–6.Google Scholar
  19. 19.
    Hudson AR, Hunter GA. Iatrogenic femoral nerve injuries. Can J Surg 1979;22:62–6.Google Scholar
  20. 20.
    Walsh C, Walsh A. Postoperative femoral neuropathy. Gynecol Obstet 1992;174:255–63.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1995

Authors and Affiliations

  • Robert C. Brasch
    • 1
  • Anthony J. Bufo
    • 1
  • Paul F. Kreienberg
    • 1
  • Garner P. Johnson
    • 1
  1. 1.Department of SurgeryAlbany Medical CollegeAlbany

Personalised recommendations