Robot-Assisted Tailored Neurectomy in Chronic Postherniorrhaphic Inguinal Neuralgia: A Retrospective Analysis

Background: Chronic postoperative inguinal pain (CPIP) is a debilitating complication after hernia repair, often resistant to conservative therapy. Traditional triple neurectomy [resection of the ilioinguinal (IIN), iliohypogastric (IHN), and genitofemoral (GFN) nerves] faces challenges such as scar tissue reoperation and nerve identification. This prospective study evaluates the safety and efficacy of robot-assisted tailored neurectomy, leveraging 3D visualization for precision. Methods: Ten consecutive patients (mean age: 46 years; 80% male) with refractory neuropathic groin pain (≥6 months) were enrolled at a university single-center (January–July 2024). Inclusion required preoperative nerve mapping, imaging (CT, MRI, and sonography) to exclude nonneuropathic causes, and failure of conservative measures (nerve blocks and analgesics). Exclusion criteria included ASA class ≥4, nonneuropathic pain, or prior triple neurectomy. Robot-assisted retroperitoneal neurectomy was performed by selectively resecting nerves (IIN, IHN, and GFN) ± mesh removal based on intraoperative findings. Results: All procedures were completed robotically (mean operative time: 60 minutes, SD: 10.1; no conversions). Mean preoperative pain scores (numeric rating scale) decreased significantly from 7.8 to 1.2 at 180 days ( P < 0.001). Opioids and neuropathic medications were discontinued in 90% of patients. Transient deafferentation (hypersensitivity) resolved within 6 weeks in 80% of cases, while 2 patients reported residual but diminishing symptoms. At 10-month follow-up, all patients reported improved daily function with no recurrences. Mean and median hospitalization was 1 day. Conclusions: Robot-assisted tailored neurectomy is a safe and effective treatment for refractory CPIP, offering precise nerve resection, minimal morbidity, and rapid recovery. The 85% reduction in pain scores and 90% opioid cessation rate align with literature success rates (85–97%). This approach overcomes limitations of open/laparoscopic techniques through enhanced visualization and adaptability. Larger studies are warranted to validate long-term outcomes and cost-effectiveness.