Comparison of Surgical Outcomes from Laparoscopic Vs Laparotomy Approach for Uterine Myomectomies Based on Fibroid Burden

Abstract

<h3>Study Objective</h3> Assess postoperative outcomes based on surgical approach for myomectomies with increasing fibroid burden. <h3>Design</h3> Retrospective analysis of benign myomectomy procedures, categorized into "smaller" and "larger" procedures based on fibroid burden identified using Current Procedural Terminology (CPT) codes. Smaller myomectomies included fibroids weighing <250mg or with 1-4 fibroids (CPT codes 58545 & 58140), and larger myomectomy procedures were classified as fibroids weighing >250mg or with >5 fibroids (CPT codes 58546 & 58146). Postoperative outcomes were then compared using the Clavien-Dindo classification system based on surgical approach, laparoscopic versus laparotomy. <h3>Setting</h3> Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. <h3>Patients or Participants</h3> Myomectomy procedures from 2014-2019 using the NSQIP® database, excluding malignancy and cases with concurrent procedures. <h3>Interventions</h3> Myomectomy via laparoscopy and laparotomy. <h3>Measurements and Main Results</h3> 8,363 total myomectomy procedures were identified. 4,667 (55.8%) were smaller myomectomy procedures; 2080 (44.6%) completed via laparoscopy and 2,587 (55.4%) via laparotomy. 3,696 (44.2%) were larger myomectomy procedures; 1,037 (28.1%) completed via laparoscopy and 2,659 (71.9%) via laparotomy. Regardless of myomectomy size, laparoscopy required less perioperative blood transfusions (p<0.01). Myomectomy via laparotomy demonstrated increased cumulative minor complications, adjusted OR 2.80 (95%CI 2.18-3.58) for smaller fibroid burden and adjusted OR 3.41 (95% CI 2.62-4.44) for larger fibroid burden. Laparotomy demonstrated increased cumulative major complications, adjusted OR 2.40 (95% CI 1.32-4.36) for larger fibroid burden. <h3>Conclusion</h3> Smaller and larger myomectomies had fewer cumulative minor complications when conducted via laparoscopy. Laparotomy for larger myomectomies significantly increased cumulative major complications including rates of small bowel obstruction and deep organ space surgical site infections. Providers should strongly consider the laparoscopic myomectomy over laparotomy, regardless of fibroid burden.