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Robotic Genitofemoral Nerve Decompression

Robotic Genitofemoral
Nerve Decompression

Beyond Groin Pain—Treating the Source at Its Origin

Genitofemoral nerve–related pain is often overlooked or misdiagnosed as inguinal, urologic, or musculoskeletal pathology. Many patients undergo multiple treatments without lasting relief because the true source of pain lies deep within the retroperitoneal and pelvic nerve pathways.

At our center, we specialize in robotic-assisted intrapelvic and retroperitoneal genitofemoral nerve decompression, allowing precise identification and treatment of pathology at the nerve’s origin and along its course.

Understanding the Condition

What Is Genitofemoral Nerve Entrapment?

The genitofemoral nerve originates from the lumbar plexus (L1–L2) and travels along the psoas muscle, dividing into genital and femoral branches. Along this course, the nerve is susceptible to:

Compression from fibrotic or inflammatory tissue
Post-surgical scarring (commonly after hernia repair or pelvic surgery)
Entrapment along the psoas or retroperitoneal space
Inflammatory processes extending from pelvic pathology

Because much of this anatomy lies deep within the retroperitoneum, it is often not accessible through conventional approaches.

Symptoms Why This Happens Why Standard Treatments Often Fail Our Surgical Approach

Symptoms

Patients with genitofemoral nerve involvement may experience:

Groin pain or burning sensation
Pain radiating to the upper anterior thigh
Testicular pain (in males) or labial pain (in females)
Hypersensitivity or numbness in the inguinal region
Pain triggered by hip extension or movement
Persistent pain after hernia or pelvic surgery

Symptoms are often confused with ilioinguinal or iliohypogastric nerve pathology, leading to incomplete treatment.

Why This Happens

Common causes include:

Post-surgical fibrosis, especially after hernia repair
Pelvic neuroinflammation
Inflammatory adipose tissue surrounding the nerve
Extension of endometriosis or pelvic inflammatory disease
Chronic irritation along the psoas muscle

In many patients, this condition is part of a broader lumbar or pelvic nerve disorder.

Why Standard Treatments Often Fail

These approaches often fail because they:

Target the distal branches rather than the nerve origin
Do not address retroperitoneal or pelvic sources of compression
Lack the ability to evaluate adjacent nerve involvement

Our Surgical Approach

We utilize a robotic retroperitoneal and intrapelvic approach, allowing direct access to the genitofemoral nerve at its origin and along its full course. This technique provides:

Safe entry into the retroperitoneal space
Identification of the nerve along the psoas muscle
Precise dissection and decompression under high-definition visualization
Preservation of surrounding vascular and neural structures

Beyond Isolated Treatment

A Truly Comprehensive Neuroanatomical Approach

Unlike traditional approaches that focus on distal nerve segments, this technique allows:

Proximal-to-distal evaluation of the nerve
Identification of multifactorial sources of pain
Simultaneous treatment of overlapping neuropathies
Removal of underlying inflammatory or endometriotic pathology

This results in a comprehensive decompression strategy, rather than isolated nerve intervention.

The Surgical Journey

What to Expect

Minimally invasive robotic procedure

High precision with minimal blood loss

Typically outpatient or short hospital stay

Surgical time varies depending on complexity

The Healing Process

Recovery & Nerve Healing

Nerve recovery is gradual:

Early symptom improvement may occur within weeks
Continued recovery over several months
Adjunct therapies may support optimal healing

Due to the minimally invasive nature of the approach, patients typically experience:

Reduced postoperative pain
Faster recovery compared to traditional approaches

Who is a candidate?

You may be a candidate if you have:

Chronic groin or inguinal pain
Pain radiating to the upper thigh or genital region
Persistent symptoms after hernia or pelvic surgery
Negative or inconclusive imaging studies
Failure of conservative treatments

Treating the Origin

The Key Difference

Traditional approaches treat the symptom at the periphery.
Our approach allows us to identify and treat the source of nerve pathology at its origin within the retroperitoneum and pelvis.

FAQ

Everything You Need

to Know

Can I drive after surgery?

For patients undergoing minimally invasive, robotic-assisted procedures, it is recommended to wait 1 week before driving on your own.

Do I have to come back to the office after surgery?

Yes. Patients are required to return to the office 2 weeks after surgery for their first post-op visit and then return for their 2nd post op visit about 4 weeks later, unless otherwise directed by Dr. Shakiba.

Do I need antibiotics after surgery?

Patients will receive antibiotics during surgery and most patient do not require any antibiotics after procedure unless there is a specific condition, in you will be notified by Dr. Shakiba

Do I need to prep my bowel prior to surgery?

Usually bowel prep prior to any bowel surgery or endometriosis surgery is unnecessary. the patient will be notified for any exceptions.

How long will I be out of work for surgery?

Depending on the complexity of the surgery, patients can expect to be out of work somewhere between 2-4 weeks. In most cases, patients undergoing a laparoscopic procedure can expect to be out of work 2 weeks while others undergoing a robotic-assisted procedure are more likely to require 4 weeks out of work.

How will my bowel function be after surgery?

It is common for patients to encounter constipation after surgery, so we advise that the patient have a bowel movement one day prior to surgery and begin taking stool softeners, such as Colace, on day 1 after surgery. Patients are advised to continue taking stool softeners within 2-4 weeks unless bowel movements are loose enough that they are no longer needed.

For a rectocele repair or other pelvic reconstruction surgery, constipation is to be expected on day 3 after procedure and is sometimes painful. If patient continues to have difficulty with bowel movements after day 3, patient advised to take Milk of Magnesia.

I cannot tolerate narcotic pain medications. Will this be an issue during my recovery?

Although we routinely send Percocet during preoperative visits for pain management after the surgery, if you cannot tolerate narcotics this will not be an issue. Fortunately due to the minimal invasive approach Dr. Shakiba takes in most of his surgeries, the severity of post-operative pain as well as the amount of blood lost during surgery is minimalized.

Most of his patients find relief through OTC NSAIDS (i.e. Ibuprofen, Motrin) for the first few days after surgery and then no longer require any type of pain medication.

If I have a sling surgery, do I need a urinary catheter after the procedure at home?

Typically, after pelvic reconstructive surgery and urinary incontinence surgery with or without the use of mesh, a test will be done following the procedure to see if your bladder is ready to resume normal function. It is common that the bladder may not be ready to function and will require an additional day of rest. In this case, you will be sent home with a catheter for 1-2 days after procedure. This is temporary and we will instruct you how to remove the catheter at home by yourself. If you are still unable to void 4-5 hours after removal of the catheter, contact our office.

If I schedule an appointment, how long can I expect to be scheduled for surgery?

Our surgical coordinator does her absolute best to schedule surgeries on dates that are convenient to the patient. However, it is ultimately dependent upon the volume of surgeries Dr. Shakiba is facing at that time and the availability of the OR.

It is highly recommended that if you are expecting time off from work in the upcoming months, or have a specific time frame of which would be more convenient for you to undergo surgery to allow yourself to have necessary recovery time, to schedule your initial visit with Dr. Shakiba 2-3 months prior to the desired time frame.

This is because depending on the procedure, Dr. Shakiba may require you to undergo additional testing prior to surgery and you will also need medical clearance from your primary care physician. It does not always take 2-3 months to schedule a surgery, but there are times of the year where patients are more inclined to want to schedule surgery (i.e. the end of the year, summer, holiday season) so by getting in early, you would be optimizing your chances to get your desired date. Regarding surgery since we use the belly button for specimen removal, we ask the patient to please make sure you adequately wash belly button and make sure there is no debris.

Should I be concerned if I notice some spotting or bleeding after surgery?

Noticing small amount of blood after surgery is normal and should diminish over time. The bleeding can be managed with the use of pads or panty-liners avoiding the use of tampons unless otherwise noted from Dr. Shakiba. However, if you are experiencing a large amount of blood or notice passage of clots with the bleeding, you should call the office immediately for reevaluation.

What is the benefit of having my procedure performed robotically?

There are many benefits to robotic-assisted procedures. Some of the few include:

Shorter recovery time
Less blood loss
Less scarring
Short hospital stays
Less post-operative pain

Will I have a big scar after surgery?

Dr. Shakiba prefers to utilize a minimally invasive approach when performing surgery on his patients, which means no big scars going up and down or across your abdomen! For patients who are eligible to undergo the minimally invasive, robotic-assisted procedures, you can expect to have 3-5 small incisions on the abdomen, one of which is often placed inside the umbilicus making it unnoticeable. Each remaining incision measures no more than an inch and are virtually unnoticeable by 10 weeks post-operative time.

Robotic Genitofemoral Nerve Decompression