Design: Retrospective before-after study design comparing pre-MIGS clinic implementation (2019) to the year after it was fully operational (2021).

Setting: Urban OB/GYN safety-net clinic serving a largely under-insured patient population with many socioeconomic barriers to care.

Patients or Participants: Patients age 18 to 55 who underwent benign surgery for fibroids. As implementing a new sub-specialty service likely changed regional referral patterns, we included only patients receiving general OB/GYN care within the safety net clinic who subsequently had fibroid surgery.

Interventions: Surgery for fibroids via minimally invasive (laparoscopic, robotic, or vaginal) or abdominal approach.

Measurements and Main Results: Seventy-four patients met inclusion criteria (22 in 2019 and 52 in 2021). Patients were predominantly non-Hispanic Black (86.4% in 2019 and 78.9% in 2021). Mean age was 44.7 and 42.5 years, respectively. Rate of laparoscopic hysterectomy increased from 40.9% (9/22) to 69.2% (36/52) (p 0.036). Rate of abdominal hysterectomy decreased from 54.6% (12/22) to 23.1% (12/52). Uterine weight increased from a mean of 562.2gm to 783.2gm (p 0.629) and mean estimated blood loss decreased from 415mL to 237mL (p 0.300), while not statistically significant both are likely clinically meaningful. There was a decrease in composite complications from 41% to 9.6% (p 0.002), with the greatest decrease in complication rates seen in blood loss >1500mL and surgical site infection. One patient required readmission and re-operation in each time frame.

Conclusion: After implementing the MIGS clinic, laparoscopic approach increased despite larger specimen weight, and composite complication rates decreased, likely due to decreased rate of abdominal hysterectomy. This exploratory study shows that implementation a safety net MIGS clinic as a promising intervention to improve equity and decrease health disparities in fibroid surgical care.