Lateral cutaneous nerve of the thigh injury during gynaecological laparoscopic procedure

Abstract

This is a case report of a woman who developed severe meralgia paraesthetica due to an injury to the lateral cutaneous nerve of the thigh. The injury occurred during a laparoscopy and adhesiolysis procedure as a result of the positioning of one of the secondary ports close to the inguinal ligament. Symptoms were reported immediately after the procedure with tingling and numbness of the upper lateral aspect of the right thigh. The symptoms persisted for more than 3 months and required strong regular analgesia. She continues to suffer significant neurological symptoms and is considering a nerve decompression procedure. The lateral cutaneous nerve of the thigh varies in its course in the abdominal wall. This is particularly variable while it crosses the inguinal ligament. Hence, any ports placed close to the inguinal ligament near to the anterior superior iliac spine may injure the nerve resulting in meralgia paraesthetica. Injury to the nerve has been reported in different types of procedures, e.g. laparoscopic inguinal hernia repair. We believe that it has not been reported previously after a gynaecological laparoscopic procedure. In this case report, we highlight the possibility of an injury to the lateral cutaneous nerve of the thigh during gynaecological laparoscopic procedures. We review the anatomy and the variations in the nerve’s course that could lead to its injury during minimal invasive gynaecological operations.