FEMORAL NEUROPATHY SECONDARY TO THE USE OF A SELF-RETAINING RETRACTOR - REPORT OF 3 CASES AND REVIEW OF THE LITERATURE

PURPOSE: Three recent cases of femoral neuropathy at our institution following colorectal surgery have been ascribed to the use of the self-retaining Bookwalter(TM) retractor. The pathophysiology of neural injury includes compression, stretch, transection, Ligation, iliopsoas hematoma, ischemia, and cement encapsulation. The aim of this study is to provide a comprehensive review of femoral nerve anatomy and mechanism of retractor injury. METHODS: The relationship of the femoral nerve to the lateral blade of the Bookwalter(TM) retractor was evaluated during colorectal surgery and in cadaveric dissections. RESULTS: The lateral blade of the self-retaining retractor was observed to either compress or impinge the intrapelvic portion of the femoral nerve. CONCLUSION: The incidence of postoperative femoral neuropathy is likely underestimated because a majority of cases are self-limited. This debilitating iatrogenic injury can be prevented with a thorough understanding of femoral nerve anatomy and careful placement of self-retaining retractor blades.