Recurrence After Robotic Myomectomy

Abstract

INTRODUCTION: GnRH agonist administration is a routine practice before myomectomy. GnRH agonist administration preoperatively not only makes myomectomy easier by decreasing the size the fibroids but also safer by decreasing operative time and blood loss. The primary objective of this study was study the association between GnRH agonist administration before robotic myomectomy and symptomatic recurrence of fibroids. METHODS: A retrospective chart review was performed and a total of 118 patients who underwent robotic-assisted laparoscopic myomectomy between January 2005 and December 2009 were analyzed. Electronic medical records of all women who were at least 2 years out from surgery were reviewed. RESULTS: We identified 17 (14.4%) symptomatic recurrences as early as 5 months to as late as 30. Recurrence group had significantly higher preoperative GnRH use (35% vs 9%; P=.009). 7.6% of all patients underwent a second surgical procedure. When comparing subset of patients who underwent a second surgical procedure, GnRH agonist use was significantly higher in patients with reoperation (56%) than those without (9%; P=.002). Cavity entry during the initial surgery was also more frequent in the reoperation group (56% vs 20%; P=.030) whereas presence of multiple fibroids, size of the largest leiomyoma, and uterine volume were not statistically significant. CONCLUSION: The overall symptomatic recurrence of uterine fibroids after a Robotic assisted Laparoscopic myomectomy was 14.4% at 2 years. Preoperative use of GnRH agonists before the surgery is associated with increased recurrence. Cavity entry during the initial surgery and GnRH use preoperatively is associated with reoperation.