Design: This is a retrospective chart review.

Setting: Conducted at a university-affiliated community hospital

Patients or Participants: A total of 162 patients referred for consultation with a MIGS subspecialist within an urban tertiary care network, from June 2021 to December 2023.

Interventions: No interventions, retrospective chart review

Measurements and Main Results: The primary outcome is percentage of patients referred for the following four conditions: fibroids, endometriosis, complex hysterectomy, or other. The secondary outcomes include the percentage from each of the four aforementioned conditions and whether they were evidence-based consultations (see publication by Shu et al).

Of those referrals, 44% were for leiomyomas (n=72). 9.8% were for endometriosis (n=16). 5.5% were for concern of a complex hysterectomy (n=9). 40% (n=65) of consults were for indications not previously aforementioned.

Of these referrals for leiomyomas, endometriosis, and complex hysterectomies, 87.5% (n=63), 75% (n=12), and 88% (n=8) were found to be evidence-based, respectively. Of the 65 consults placed for a separate unlisted indication, 3.1% (n=2) were found to be evidence-based.

Conclusion: The majority of patients that are referred to MIGS subspecialists include surgery for advanced stage endometriosis and complex hysterectomies. The majority of referrals that were placed for leiomyomata, endometriosis, and complex hysterectomy. These referrals were found to be evidence-based 75% or more of the time. However, a large number of referrals were placed for another indication, specifically 40%, and of that large portion of referrals, only 3.1% are evidence based. It will be critical as MIGS obtains ABOG subspecialty status to create a system for appropriate models, as well as develop wider scopes for evidence-based referral to a minimally invasive gynecologic surgeon as this may help to evaluate those causes that did not fall into the three previously defined evidence-based categories.