Meralgia Paresthetica: An Anatomical Review and Surgical Case Presentation Utilizing a Robotic Exoscope

Background: Meralgia paresthetica (MP) is a neuropathic condition marked by pain, tingling, and numbness in the anterolateral thigh, primarily caused by compression of the lateral femoral cutaneous nerve (LFCN). Although compression often occurs beneath the inguinal ligament, anatomical variations can lead to different entrapment sites. Treatments range from conservative measures to surgical decompression, depending on symptom severity. This study provides an anatomical review of the LFCN and presents a unique case of MP where the LFCN was compressed by the sartorius fascia rather than the typical site beneath the inguinal ligament. The study also explores the use of the Synaptive Modus X robotic exoscope for surgical decompression. Methods: This article presents a case study of a man in his 40s with a 15-year history of chronic MP symptoms, where the LFCN was atypically compressed by the sartorius fascia. Surgical decompression was performed using the robotic exoscope, a device offering high-definition, 3-dimensional visualization. Results: At 13 weeks postoperatively, the patient experienced improvement in thigh sensation and no pain. He returned to baseline ambulation with no complications. The exoscope allowed precise identification of the LFCN's anatomy and compression site, proving effective in enhancing surgical precision. Conclusions: This is the first report of primary LFCN decompression using the Synaptive Modus X exoscope. The device provides excellent visualization, ergonomic benefits, and educational advantages, making it a valuable alternative to traditional microscopes and loupes in nerve decompression and other microsurgical procedures. Further studies are needed to assess its cost-effectiveness and broader applications in plastic surgery.