Design: A trust-wide multicentre retrospective study

Setting: Four secondary/tertiary care hospitals

Patients or Participants: Women undergoing myomectomy via laparoscopy and laparotomy

Interventions:

A retrospective review was performed of all myomectomies performed across the trust from 2015 to 2022. We used previously published criteria to determine which open myomectomy cases could have been appropriate for laparoscopic myomectomy based upon the pre-operative imaging. The criteria were (i) that there were fewer than three fibroids, (ii) that the largest fibroid was no greater than 10cm in diameter and (iii) even if there was a solitary fibroid it should be no greater than 10cm in diameter. We estimated potential cost differences using Healthcare Resource Group (HRG) codes.

Measurements and Main Results:

855 abdominal myomectomies were performed across four hospital sites. 202 (24%) cases were performed laparoscopically. Of the 584 open myomectomies with scan data, 190 could have been performed laparoscopically. Across 4 hospital sites, the proportion of laparoscopic cases varied; site 1 = 4%, site 2= 53%, site 3 =20%, site 4 = 0%. By applying the scan criteria these proportions increase to 34%, 63%, 45% and 100% respectively. Overall, 46% of women could have had laparoscopic myomectomy versus 24%, with a potential cost saving of £74,000.

Conclusion:

There is potential to increase the proportion of laparoscopic myomectomies performed. We hypothesise that the current dearth of laparoscopic cases reflects the lack of advanced laparoscopic training opportunities. We are doing women a disservice by being unable to offer gold standard treatment to all women, no matter where they live.