Safe Obturator Nerve Identification During Pelvic Lymphadenectomy for High-Risk Endometrial Cancer.

Background: Endometrial cancer (EC) is the most frequent gynecological cancer and the fourth in western women. To date, although the sentinel lymph node technique is the gold standard in low-risk EC patients, pelvic and lumboaortic lymphadenectomy is still suggested by international guidelines for staging purposes in high-risk EC patients. Pelvic lymphadenectomy is burdened by surgical complications ranging from vascular, nerve, intestinal, and lymphatic-related injuries. Furthermore, due to its proximity to the large pelvic vessels, the obturator nerve is the most frequently injured in gynecological surgery. The identification of the obturator nerve can take place either through the mediolateral approach through the lateral paravesical fossa or with a lateromedial approach through the iliolumbar fossa. To date, no specific approach is recommended and each surgeon will perform the approach they are most confident with.