Feasibility and Perioperative Outcomes of Minimally Invasive Higher Order Myomectomy

Marie-Claire Leaf; Alexandra Lombardo; Julia J Wainger; Mostafa A Borahay; Anja Frost; Kristin Patzkowsky; Karen C Wang; Harold Wu; Khara Simpson

doi:10.1016/j.jmig.2024.04.024

Feasibility and Perioperative Outcomes of Minimally Invasive Higher Order Myomectomy

J Minim Invasive Gynecol. 2024 May 3:S1553-4650(24)00202-4. doi: 10.1016/j.jmig.2024.04.024. Online ahead of print.

Authors

Marie-Claire Leaf¹, Alexandra Lombardo², Julia J Wainger³, Mostafa A Borahay⁴, Anja Frost⁴, Kristin Patzkowsky⁴, Karen C Wang⁴, Harold Wu⁴, Khara Simpson⁴

Affiliations

¹ Division of Minimally Invasive Gynecologic Surgery, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (Drs. Leaf, Borahay, Frost, Patzkowsky, Wang, Wu, and Simpson). Electronic address: marieclaire.leaf@gmail.com.
² Johns Hopkins School of Medicine, Baltimore, MD (Lombardo).
³ Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (Dr. Wainger).
⁴ Division of Minimally Invasive Gynecologic Surgery, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (Drs. Leaf, Borahay, Frost, Patzkowsky, Wang, Wu, and Simpson).

PMID: 38705376
DOI: 10.1016/j.jmig.2024.04.024

Abstract

Study objective: To investigate perioperative outcomes of minimally invasive higher order myomectomy as defined by removal of 10 or more fibroids.

Design: A retrospective cohort study between January 2018 and December 2022.

Setting: A tertiary academic medical center.

Patients: Women who underwent minimally invasive myomectomy via laparoscopic or robotic approach.

Interventions: Surgical intervention in the form of minimally invasive myomectomy.

Measurements and main results: A total of 735 women met inclusion criteria of whom 578 had fewer than 10 fibroids removed, and 157 patients had 10 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). Body mass index was similar in both groups (p = .66) and patients with higher order myomectomy were more likely to have a history of 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 myomectomy, EBL remained significantly higher in patients with 10 or more fibroids removed (p = .02).

Conclusion: EBL 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 10 fibroids removed, highlighting the feasibility of minimally invasive higher order myomectomy.

Keywords: Fibroids; Minimally invasive surgery; Myomectomy.