Is burning pain under an incision site 2 weeks post-total hysterectomy with bilateral salpingo-oophorectomy (BSO) via DaVinci Robotic assisted laparoscopic surgery normal, and what does nerve pain typically feel like?

Burning Pain at Incision Site 2 Weeks Post-Robotic Hysterectomy

Yes, burning pain under an incision site 2 weeks after robotic-assisted laparoscopic hysterectomy is a normal finding and most likely represents nerve regeneration or neuropathic pain from surgical nerve injury, which typically resolves spontaneously within 3-6 months.

Understanding Post-Surgical Nerve Pain

Burning pain at incision sites is characteristic of neuropathic pain from nerve injury during surgery, which is a common and expected complication of any surgical procedure 1.

What Nerve Pain Feels Like

Neuropathic pain has distinct characteristics that differentiate it from other types of post-surgical pain:

• Burning or electric-shock sensations that are precisely localizable to the incision area 1
• Dysesthesias (abnormal sensations) including tingling, pins-and-needles, or hypersensitivity to touch 1
• Pain that may be worse with certain movements or positions but is often present at rest 1
• The pain is typically focal and reproducible when the patient or physician touches the area 1

Why This Occurs After Robotic Hysterectomy

Nerve injury during laparoscopic procedures is common, occurring in approximately 0.03% to 20.9% of surgical cases depending on the procedure type 2, 3. The mechanisms include:

• Direct trauma to small cutaneous nerves during trocar placement 2
• Traction injury from tissue manipulation and retraction 2, 3
• Thermal injury from electrocautery or energy devices used during surgery 2

The lateral abdominal wall nerves (intercostal nerves, iliohypogastric, and ilioinguinal nerves) are particularly vulnerable during port placement for robotic surgery 1.

Expected Clinical Course

Most nerve injuries after minimally invasive surgery are transient neurapraxias that resolve completely within 3-6 months 2, 3:

• The majority of patients experience spontaneous resolution without intervention 2
• Permanent sequelae are rare after laparoscopic procedures 2
• Recovery typically follows nerve regeneration patterns, with gradual improvement over weeks to months 2

Management Approach

When Incisions Look Normal (Current Scenario)

Conservative management with reassurance and symptom control is appropriate 1:

• Multimodal analgesia including NSAIDs and acetaminophen for baseline pain control 1
• Neuropathic pain medications if burning pain is severe or interferes with function 1:
  • Gabapentin or pregabalin (anticonvulsants) 1
  • Tricyclic antidepressants in low doses 1
  • Topical lidocaine patches applied directly over the painful area 1

Red Flags Requiring Further Evaluation

While nerve pain is expected, certain findings warrant immediate reassessment 1:

• Signs of infection (redness, warmth, purulent drainage, fever) 1
• Expanding hematoma or new swelling at the incision site 1
• Progressive neurological deficits beyond the incision area 1
• Severe pain unresponsive to oral analgesics 1

Important Clinical Caveats

Patient factors may influence nerve injury risk and recovery 3:

• Hypertension, diabetes mellitus, and tobacco use are significantly associated with higher rates of perioperative nerve injuries 3
• Female patients appear more susceptible to nerve complications after surgery 2
• These factors may prolong recovery time but do not change the overall favorable prognosis 2, 3

Neuropathic pain is less responsive to opioids than inflammatory or nociceptive pain, so escalating opioid doses is not the appropriate strategy 1. Instead, targeted neuropathic pain medications should be initiated if symptoms are bothersome 1.