Obturator Neuropathy Following Minimally Invasive Pelvic Surgery: A Report of Two Cases

Post-surgical neuropathies are uncommon but clinically significant complications of minimally invasive pelvic procedures. Obturator nerve injury, in particular, remains underrecognized in the context of hysterectomy and prostatectomy. We present two cases of iatrogenic obturator mononeuropathy and review the relevant literature. Case 1 involved a 45-year-old man with metastatic prostate adenocarcinoma who developed proximal left leg weakness one month after robotic-assisted radical prostatectomy. Case 2 involved a 40-year-old woman with grade 1 endometrial carcinoma who experienced similar right leg weakness following laparoscopic radical hysterectomy. Both patients reported weakness in the immediate postoperative period. Neurological examination demonstrated impaired thigh adduction with preserved hip and knee strength and intact reflexes. Imaging of the lumbar spine was unremarkable, while electromyography revealed obturator mononeuropathy. Rehabilitation resulted in complete functional recovery within six months. Obturator neuropathy is uncommon in patients following major pelvic surgery, most often due to intraoperative stretch, compression, or electrosurgical injury. Prompt recognition and rehabilitation are essential to optimize outcomes.