Femoral Nerve Compression Injury and Tubal Microsurgery

Abstract

A survey was made of doctors to determine if femoral nerve compression injury, an uncommon complication of laparotomy, is more common in tubal microsurgical reconstruction. Questionnaires were sent to persons in North America known to have performed tubal reconstructions. In the 6 or 7 individuals who provided information, a total of 5 femoral nerve injuries were reported in 1620 cases, for an incidence of 1 in 324. All nerve damage occurred with the O'Connor-O'Sullivan retractor. Tubal microsurgery differs from laparotomies and predisposes to femoral nerve damage because of: 1) necessity of a wide incision, placing the lateral blades of the retractor closer to the area of the nerve; 2) necessity of stabilizing the operating hand; 3) requirement of tilting the patient toward the operator; 4) length of time required for the procedure. The following precautions are presented: 1) avoid using the O'Connor-O'Sullivan retractor for tubal reconstruction, particularly in thin patients; 2) when placing the retractor, check the relationship of the lateral blade to the area of the nerve with downward and outward pressure on the retractor; and 3) use an arm rest during surgery.