Skip to main content
SpringerLink
Log in

Robot-assisted triple neurectomy for iatrogenic inguinal pain: a technical note

  • Technical Note -- Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Painful neuromas are a relatively common complication of hernia and abdominal wall surgery.

Objective

Surgical neurectomy has the potential to to provide durable relief for chronic pain; however, current surgical approaches are not without morbidity or anatomical challenges.We sought a surgical alternative.

Methods

In the treatment of a case of incapacitating inguinal pain, we performed an anterior transperitoneal approach using a surgical robot.

Results

This approach was facile and provided elegant anatomical visualization.

Conclusion

This case describes the first known robot-assisted laparoscopic triple neurectomy and details a simplified, transperitoneal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76

    Article  CAS  PubMed  Google Scholar 

  2. Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801

    Article  CAS  PubMed  Google Scholar 

  3. Alfieri S, Rotondi F, Di GA, Fumagalli U, Salzano A, Di MD, Ridolfini MP, Sgagari A, Doglietto G (2006) Influence of preservation versus division of ilioinguinal, iliohypogastric, and genital nerves during open mesh herniorrhaphy: prospective multicentric study of chronic pain. Ann Surg 243:553–558

    Article  PubMed  Google Scholar 

  4. Amid PK (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137:100–104

    PubMed  Google Scholar 

  5. Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314

    Article  CAS  PubMed  Google Scholar 

  6. Dakwar E, Le TV, Baaj AA, Le AX, Smith WD, Akbarnia BA, Uribe JS (2011) Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion. Neurosurg Focus 31:E18

    Article  PubMed  Google Scholar 

  7. Ducic I, Dellon AL (2004) Testicular pain after inguinal hernia repair: an approach to resection of the genital branch of genitofemoral nerve. J Am Coll Surg 198:181–184

    Article  PubMed  Google Scholar 

  8. Gray H, Standring S, Ellis H, Berkovitz BKB (2005) Gray’s anatomy: the anatomical basis of clinical practice. Elsevier Churchill Livingstone, New York

    Google Scholar 

  9. Huang TJ, Hsu RW, Liu HP, Hsu KY, Liao YS, Shih HN, Chen YJ (1997) Video-assisted thoracoscopic treatment of spinal lesions in the thoracolumbar junction. Surg Endosc 11:1189–1193

    Article  CAS  PubMed  Google Scholar 

  10. Kim DH (2008) Kline & Hudson’s nerve injuries: operative results for major nerve injuries, entrapments and tumors. WB Saunders

  11. Klaassen Z, Marshall E, Tubbs RS, Louis RG Jr, Wartmann CT, Loukas M (2011) Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat 24:454–461

    Article  PubMed  Google Scholar 

  12. Krahenbuhl L, Striffeler H, Baer HU, Buchler MW (1997) Retroperitoneal endoscopic neurectomy for nerve entrapment after hernia repair. Br J Surg 84:216–219

    Article  CAS  PubMed  Google Scholar 

  13. Lee CH, Dellon AL (2000) Surgical management of groin pain of neural origin. J Am Coll Surg 191:137–142

    Article  CAS  PubMed  Google Scholar 

  14. Leibl BJ, Daubler P, Schmedt CG, Kraft K, Bittner R (2000) Long-term results of a randomized clinical trial between laparoscopic hernioplasty and shouldice repair. Br J Surg 87:780–783

    Article  CAS  PubMed  Google Scholar 

  15. Lyon EK (1945) Genitofemoral causalgia. Can Med Assoc J 53:213–216

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Magee RK (1942) Genitofemoral causalgia: (a new syndrome). Can Med Assoc J 46:326–329

    CAS  PubMed Central  PubMed  Google Scholar 

  17. McAfee PC, Regan JR, Zdeblick T, Zuckerman J, Picetti GD III, Heim S, Geis WP, Fedder IL (1995) The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine (Phila Pa 1976) 20:1624–1632

    Article  CAS  Google Scholar 

  18. Mikkelsen T, Werner MU, Lassen B, Kehlet H (2004) Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anesth Analg 99:146–151

    Article  PubMed  Google Scholar 

  19. Murovic JA, Kim DH, Tiel RL, Kline DG (2005) Surgical management of 10 genitofemoral neuralgias at the Louisiana State University Health Sciences Center. Neurosurgery 56:298–303

    Article  PubMed  Google Scholar 

  20. Muto CM, Pedana N, Scarpelli S, Galardo R, Guida G, Schiavone V (2005) Inguinal neurectomy for nerve entrapment after open/laparoscopic hernia repair using retroperitoneal endoscopic approach. Surg Endosc 19:974–976

    Article  CAS  PubMed  Google Scholar 

  21. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194:394–400

    Article  PubMed  Google Scholar 

  22. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54

    Article  PubMed  Google Scholar 

  23. Rab M, Ebmer AJ, Dellon AL (2001) Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 108:1618–1623

    Article  CAS  PubMed  Google Scholar 

  24. Rozen WM, Tran TM, Ashton MW, Barrington MJ, Ivanusic JJ, Taylor GI (2008) Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat 21:325–333

    Article  CAS  PubMed  Google Scholar 

  25. Song JW, Wolf JS Jr, McGillicuddy JE, Bhangoo S, Yang LJ (2011) Laparoscopic triple neurectomy for intractable groin pain: technical report of 3 cases. Neurosurgery 68:339–346

    Article  PubMed  Google Scholar 

  26. Starling JR, Harms BA, Schroeder ME, Eichman PL (1987) Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery 102:581–586

    CAS  PubMed  Google Scholar 

  27. Viswanathan A, Kim DH, Reid N, Kline DG (2009) Surgical management of the pelvic plexus and lower abdominal nerves. Neurosurgery 65:A44–A51

    Article  PubMed  Google Scholar 

  28. Wright D, Paterson C, Scott N, Hair A, O’Dwyer PJ (2002) Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg 235:333–337

    Article  PubMed  Google Scholar 

  29. Zaluska S (1975) External structure of the ilioinguinal nerve in postfetal life in man. Folia Morphol 34:419–424

    Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, 85013, USA

    Mark A. Mahan

  2. Division of Urology, University of California, San Diego, La Jolla, CA, 92093, USA

    Andrew K. Kader

  3. Division of Neurosurgery, University of California, San Diego, La Jolla, CA, 92093, USA

    Justin M. Brown

Authors
  1. Mark A. Mahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew K. Kader
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark A. Mahan.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Operative video from a robot-assisted laproscopic transperitoneal triple neurectomy. Anatomical identification of the relevant nerves are depicted. Used with permission from Barrow Neurological Institute. (MPEG 86228 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mahan, M.A., Kader, A.K. & Brown, J.M. Robot-assisted triple neurectomy for iatrogenic inguinal pain: a technical note. Acta Neurochir 156, 171–175 (2014). https://doi.org/10.1007/s00701-013-1857-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1857-z

Keywords

Search

Navigation