Feasibility, Safety, and Prediction of Complications for Complex Minimally Invasive Myomectomy [12J]

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Abstract

INTRODUCTION:

The purpose of this study is to assess perioperative outcomes and predict complications for complex minimally invasive myomectomy.

METHODS:

This is a retrospective cohort study of women undergoing a minimally invasive surgical (MIS) approach to myomectomy by three fellowship-trained surgeons from April 2011 to December 2014.

RESULTS:

The cohort included 221 patients, of which 47.5% had laparoscopic myomectomy and 52.5% had a robotic myomectomy. The mean (SD) specimen weight in grams, dominant myoma diameter in centimeters, and number of myomata removed were 408.1 (384.9), 9.6 (5.1), and 4.5 (4.1), respectively. The total complication rate was 10.4%. The rate of hemorrhage was 8.6% and the rate of transfusion was 4.1%. These accounted for most complications. Women with complications had larger dominant myoma diameter (mean [SD] in cm 15.2 [6.4] versus 9.5 [4.49], P=.002), and greater number of myomata removed (mean [SD] 6.7 [6.3] versus 4.3 [3.7], P=.031). A logistic regression model combining both diameter of dominant myoma and number of myomata removed reliably predicted complications while minimizing false positives.

CONCLUSION:

Our cohort had higher specimen weights, larger dominant myoma diameter, and number of myomata removed in comparison to other reports of MIS myomectomy. Complication rates remained equivalent and hemorrhage and transfusion were the most prevalent. A combination of diameter of dominant myoma and number of myomata removed predicted complications while minimizing false positives. Both factors can be easily defined prior to surgery and can be potentially used to guide referral patterns, pre-operative counseling, and the implementation of preventative measures.

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