Durability of Laparoscopic Myomectomy

Abstract

Study Objective To determine the time to re-intervention for fibroid symptoms following robotic or laparoscopic myomectomy by sub-specialty trained gynecologic surgeons. Design Retrospective cohort of patients who underwent robot-assisted and traditional laparoscopic myomectomy from 2005 through 2019 at tertiary care academic hospitals operating in Arizona, Florida, and Minnesota. Setting Three tertiary-care academic hospitals. Patients or Participants Electronic medical record database was surveyed using CPT codes for laparoscopic myomectomy yielding 592 charts, all of which were reviewed. After exclusion of those who underwent myomectomy for an indication other than symptoms attributable to uterine fibroids 451 patient charts remained for analysis. Interventions Any treatments targeting a symptom attributed to uterine fibroids following initial surgery were considered “retreatment.” Both medical and surgical managements were included. Measurements and Main Results Cumulative incidence curves were calculated for time to retreatment event and log-rank tests used to compare curves between: route of laparoscopic myomectomy, age group, BMI, race, parity, diagnosis group, FIGO grade, and myoma weight. Overall incidence of retreatment was 5.96% per year. Women less than 40 years of age were significantly more likely to require retreatment, 8.22% per year, compared to those older than 40, 4.18% per year (p=0.003). There were no significant differences between time to treat based on any other demographic. Thirteen percent of patients required retreatment and the majority (26, 44%) of these 59 patients underwent hysterectomy, followed by repeat myomectomy (13, 22%), and medical management (13, 22%). Conclusion The incidence of retreatment was found to be less than 6% per year for minimally invasive myomectomy, and only 13% of patients required some form of re-intervention demonstrating that minimally invasive myomectomy is a durable procedure for treatment of symptomatic fibroids. Further, the longevity of this treatment is greater in patients older than 40, as compared to their younger counterparts.