Genitofemoral Nerve Sparing Adhesiolysis

Abstract

Video Objective The objective of this video is to review the anatomical landmarks, innervations and mechanisms of injury of the genitofemoral nerve in order to avoid its injury in cases with significant pelvic adhesions. Setting The patient is a thirty-two-year-old gravida three para three who is known for endometriosis. She previously underwent a caesarean hysterectomy for invasive placentation. She presented with chronic pelvic pain. She tried numerous medical treatments; only GnRH agonist controlled her pain. She was therefore consented for laparoscopic bilateral salpingo-oophorectomy which was performed at a tertiary care center by the minimally invasive gynecology surgery team. She had extensive abdominal and left pelvic side wall adhesions. In fact her left ovary was severely adherent onto the left external iliac artery and genitofemoral nerve. Interventions During the laparoscopic bilateral salpingo-oophorectomy, adhesiolysis and dissection near the genitofemoral nerve and external iliac artery were performed. Conclusion In the case of severe pelvic side wall adhesions and absence of a uterus, recognition of pelvic landmarks is of paramount importance. This facilitates identification of other pelvic structures and in this case, prevented injury to the external iliac artery and the genitofemoral nerve. Furthermore, careful tissue handling and dissection techniques are crucial. These help to maintain minimal blood loss, develop surgical planes and avoid injuries to pelvic structures.