{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T18:59:13Z","timestamp":1777921153989,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T00:00:00Z","timestamp":1443657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2015,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Obturator nerve injury (ONI) is a rare complication during pelvic lymph node dissection (PLND), in extraperitoneal laparoscopic radical prostatectomy (e-LRP), and\/or extraperitoneal robotic-assisted laparoscopic radical prostatectomy (e-RALP). It is important to recognize ONI during the initial operation, maximizing the feasibility of simultaneous repair. Here we report our experience with ONI during e-LRP\/e-RALP procedures and draw an injury risk map.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      Between December 1999 and November 2014, 2531 e-LRPs and 1027 e-RALPs were performed. Five patients (3 during e-LRP, 2 during e-RALP) experienced ONI in the proximal part of the nerve. Obturator nerves were clipped during the 3 e-LRP cases. Clips were immediately removed, and patients received physiotherapy with medical treatments in the postoperative period. During e-RALP, two obturator nerves were transected and subsequently repaired using the robotic Da Vinci\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). ONI types were investigated in detail in these patients, and current published studies were analyzed in order to draw a risk map.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean follow-up was 18.8\u2009\u00b1\u20092.7 months. In total, 3558 cases (2531 e-LRPs, 1027 e-RALPs) were performed. ONI occurred in 3 e-LRP (0.1%) and 2 e-RALP (0.1%) patients. Simultaneous repair was performed successfully in all cases, as clips were removed in e-LRP cases and obturator nerves were repaired using 6\/0 polypropylene (Prolene\n                      <jats:sup>\u00ae<\/jats:sup>\n                      ; Ethicon, Somerville, NJ) suture in e-RALP cases. There was no complication associated with obturator nerve functions such as adductor function and\/or neurologic deficiency during long-term follow-up. In view of published studies in the literature, the proximal part of the obturator nerve is at highest risk for injury during PLND, representing 77.8% of reported cases of ONI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>According to our ONI risk map, the proximal part of the obturator nerve is at higher risk for injury during PLND. Careful dissection and a good knowledge of pelvic anatomy are essential for preventing ONI. Successful ONI management can be performed simultaneously in experienced hands.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lap.2015.0190","type":"journal-article","created":{"date-parts":[[2015,9,29]],"date-time":"2015-09-29T16:35:27Z","timestamp":1443544527000},"page":"826-832","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":22,"title":["Is It Possible to Draw a Risk Map for Obturator Nerve Injury During Pelvic Lymph Node Dissection? The Heilbronn Experience and a Review of the Literature"],"prefix":"10.1177","volume":"25","author":[{"given":"Ali Serdar","family":"G\u00f6zen","sequence":"first","affiliation":[{"name":"University of Heidelberg","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tevfik","family":"Aktoz","sequence":"additional","affiliation":[{"name":"Trakya University School of Medicine","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yigit","family":"Akin","sequence":"additional","affiliation":[{"name":"University of Heidelberg","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Klein","sequence":"additional","affiliation":[{"name":"University of Heidelberg","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Rieker","sequence":"additional","affiliation":[{"name":"University of Heidelberg","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Rassweiler","sequence":"additional","affiliation":[{"name":"University of Heidelberg","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,10,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2007.04.073"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2005.12.054"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-4295(93)90647-S"},{"key":"e_1_3_2_5_2","first-page":"163","volume-title":"Atlas of the Prostate","author":"Touijer K","year":"2005","unstructured":"Touijer K, , Guillonneau B. 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Transection of the obturator nerve by an electrosurgical instrument and its immediate repair during laparoscopic pelvic lymphadenectomy: A case report. 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