Feasibility and Perioperative Outcomes of Minimally Invasive Higher Order Myomectomy

Abstract

Study ObjectiveTo investigate perioperative outcomes of minimally invasive higher order myomectomy as defined by removal of ten or more fibroids. DesignA retrospective cohort study between January 2018 and December 2022 SettingA tertiary academic medical center. Patients or ParticipantsWomen who underwent minimally invasive myomectomy via laparoscopic or robotic approach. InterventionsSurgical intervention in the form of minimally invasive myomectomy. Measurements and Main ResultsA total of 735 women met inclusion criteria of which 578 had fewer than ten fibroids removed, and 157 patients had ten or more removed (average number of fibroids removed 3.8 vs 14.7, p < .001; specimen's weight 317.4 g vs 371.0 g, p = .07). BMI was similar in both groups (p = .66) and patients with higher order myomectomy were more likely to have a history of prior myomectomy (12.0% vs 26.8%, p < .001).The average estimated blood loss (EBL) was 246 mL vs 470 mL in each group (p < .001). There were no significant differences in packed red blood cell transfusion (1.0% vs 0.6%, p = .65), conversion to laparotomy (0.5% vs 0.6%, p = .86), or complications including visceral injury, wound complication, venous thromboembolism, ileus, or readmission (5.9% vs 4.5%, p = .49). The hospital length of stay was similar in both groups (0.5 days vs 0.5 days, p = .63).On linear regression analysis, after adjusting for specimen's weight, operative time, and history of prior myomectomy, EBL remained significantly higher in patients with ten or more fibroids removed (p= .02). ConclusionEBL is increased in higher order myomectomy, however, blood transfusions, conversion to laparotomy, complication rates, and length of hospital stay did not differ compared with patients with fewer than ten fibroids removed, highlighting the feasibility of minimally invasive higher order myomectomy.