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

Setting: A tertiary academic medical center.

Patients or Participants: 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. 578 of them had fewer than ten fibroids removed while 157 patients had ten or more fibroids removed (average number of fibroids removed 3.8 vs 14.7, p < 0.001; specimen’s weight 317.4 g vs 371.0 g, p = 0.07). BMI was similar in both groups (p = 0.66) and patients with higher order myomectomy were more likely to have a history of prior myomectomy (12.0% vs 26.8%, p < 0.001).

The average estimated blood loss (EBL) was 246 mL vs 470 mL in each cohort (p < 0.001). There were no differences in packed red blood cell transfusion (1.0% vs 0.6%, p = 0.65), conversion to laparotomy rate (0.5% vs 0.6%, p = 0.86), or complication rates including visceral injury, wound complication, venous thromboembolism, ileus, or readmission (5.9% vs 4.5%, p = 0.49). The hospital length of stay was similar in both groups (0.5 days vs 0.5 days, p = 0.63).

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 = 0.02).

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 ten fibroids removed, highlighting the safety and feasibility of minimally invasive higher order myomectomy.