Best Methods to Prevent Nerve Injury During Gynecologic Surgery

Gynecologic surgery can be very tricky and it’s not uncommon for patients to sustain injury to their upper and lower extremities. While the latter has a higher rate of occurrence, most of these injuries are transient in nature, and they soon get resolved by themselves. Unfortunately, in a few rare cases, the injuries don’t heal and lead to long-time problems.

Types of Gynecological Nerve Injuries

Nerve injuries during gynecologic surgery can be divided into three separate categories, viz. axonotmesis, neurotmesis, and neuropraxia. Axonotmesis occurs due to the severe decompression of axons, and this takes a long time to heal. On the other hand, neuropraxia takes place owing to nerve demyelination at the area of injury from compression and gets resolved within a few weeks to some months. Neurotmesis occurs due to total transaction and is related to poor prognosis minus reparative surgical procedures.

How It Works

Gynecologic surgery takes place vaginally through minimally invasive surgery or laparotomy. Robotic or laproscopic assistance is a must during the process. Each of these surgical processes carries with it a certain type of risk and may cause nerve injury. Stretch and compression injuries usually occur due to the improper or prolonged positioning of the patient, and the placement of the retractor. The occurrence of transaction injuries is rarer. Entrapment injuries, on the other hand, are related to lower loss of functions but the amount of pain sustained is a lot higher.

Below you’ll find a list of things to keep in mind while performing gynecologic surgery to avoid nerve damage.

Tips and Tricks

When the neurosurgeon tucks a patient’s arm to conduct minimally invasive surgery, suitable padding needs to be placed near the wrist and the elbow. Moreover, the arm must be placed in a “thumbs-up” position. The shoulder blocks need to be placed across the patient’s acromioclavicular joint. At the time that a laproscopy is being performed, it is important that the surgeon use the shortest blade to enable sufficient visualization. They need to check the blades at the time of the procedure to make sure additional pressure isn’t applied on the psoas muscle. The pressure exerted on the lateral blades needs to be released at regular intervals in the middle of the procedure. The stirrups must be placed at the same height and it needs to be ensured that the leg remains in line with the contralateral shoulder of the patient. The surgeon should be careful to ensure that the lateral fibula doesn’t touch the stirrup and the padding is placed properly between the stirrup and the fibular head.

Care should be taken to prevent the low transverse incision from extending past the lateral margin of the rectus muscle. Moreover, the facial closure suture should not be more than 1.5 cm from the fascial incision’s lateral edge to prevent catching the nerve in the suture. The surgeon should be extra careful in identifying and sparing the nerve at the time of external iliac node removal or retroperitoneal dissection.

It’s common for nerve injuries to take place during gynecologic surgery, and these are often a major reason behind morbidity in the patient. Though they’re sometimes unavoidable and are a part of the surgical procedure, injury can often be prevented by paying suitable attention and checking the position in which the patient is placed and the use of the retractor. Thus, it’s important for gynecologists to be aware of the risks and have in-depth knowledge about the anatomy. However, if any injury does occur, the surgeon should assure the patient that no damage has occurred and a full recovery is possible.

Treating a Pinched Nerve – Here’s What to Do

It is extremely uncomfortable leading a regular life when you’re suffering from a pinched nerve. Though it’s not harmful, it might cause numbness and pain which could hamper daily activities. It’s not uncommon for a person to experience nerve problems in the back and the neck. Often, these problems get resolved on their own, but frequently, they might recur again and again. This causes a lot of damage to the nerve and leads to marked symptoms. Thankfully, there are several methods to take care of a pinched nerve and get some comfort.

Treatment Options

The pain and discomfort one experienced from a pinched nerve gets worse if left untreated for a long time. Several modes of treatment are available, including both non-surgical and surgical options. Based on the severity and area affected, the surgeon might advice you on the best method to treat your condition. Moreover, they can recommend how to avoid such problems in the future. But it’s commonly seen that surgery is the best option available to patients since it promises to deliver permanent relief and helps them lead a normal life without any hassle.

Surgery Methods

The first thing that needs to be done is to figure out the root cause of the pinched nerve. Is there some deep-rooted reason or is it merely a passing episode? If you think that the damage sustained to your nerves is far too much for conservative methods to work, surgery might be the only possible solution left to you.

Keep in mind that a pinched nerve surgery is not something that any random doctor is capable of handle; it should be attempted only by someone highly qualified who has prior experience dealing with this kind of problem. You should speak to them extensively and resolve all your doubts and concerns regarding the surgery. Moreover, you should check whether they feel comfortable performing the surgery on you.

Most of the pinched nerve surgeries that take place are minimally invasive. This makes them easier and faster to recover from. Based on the area affected, the neurosurgeon might decide to perform a laminectomy, a microdiscectomy, or foraminotomy. They could also decide to go with a lumbar spine fusion or an anterior cervical discectomy.

Thankfully, all of these procedures may be performed in a manner that is the least invasive. This is a great development in the field of modern surgery. The period of recovery is also quite short, and most patients can resume their normal activities within a span of six weeks. In a lot of instances, only a couple days are required to recover from the surgery and return to regular duties like cooking, bathing, and other non-strenuous, minor activities. You can go back to leading a normal life within a span of three to four months, and experience very little discomfort and pain.

If you believe that you’re suffering from this condition, it’s best to seek treatment as early as you can. The more you dawdle, the worse your condition becomes until it’s irreversible.