Femoral Neuropathy—A Neurological Complication of Hysterectomy

A study of the clinical findings of ten patients in whom femoral neuropathy developed following hysterectomy and 36 cases reported in the literature, along with an anatomical reinvestigation of 14 cadavers, has led to the realization that the pathogenesis of the neuropathy is continuous pressure exerted by retractor blades on the greater psoas muscle. This produces ischemia of the femoral nerve. Self-retaining retractors are most often to blame. A preventive measure would be palpation of the femoral artery after pelvic retractor is in place. Repositioning of retractor blades should be performed until pulsations are perceived in this artery. This neural complication need create little concern, for it is almost always fully reversible.