Design: Retrospective cohort study

Setting: Community health care system

Patients or Participants: Patients undergoing abdominal, laparoscopic, or robotic assisted laparoscopic myomectomies between March 2018 and December 2023 by both general gynecologists and minimally invasive gynecologic surgeons

Interventions: N/A

Measurements and Main Results: Data from 281 patients was collected and included for analysis. One-hundred and twenty-four (44.2%) patients were found to have a fibroid weight less than 250 grams. Sixty-seven (23.8%) patients had a fibroid weight between 250 and 500 grams. Ninety (32.0%) patients had a fibroid weight greater than 500 grams. Abdominal myomectomies had a higher percentage of fibroids removed that weighed greater than 500 grams total (48.5% vs 16.6%), overall abdominal myomectomies were associated with higher fibroid specimen weights (median 482 grams vs 204 grams for MI). However, when comparing median weights between approaches by the following categories: less 250 grams, 250-500 grams, and greater than 500 grams, abdominal myomectomies were associated with higher fibroid weight for only the less than 250-gram weight group. The other two categories of fibroid weights (250-500 grams and greater than 500 grams) did not have a statistically significantly difference between surgical approaches. After adjusting for baseline demographics with a multivariable linear regression, these results held true.

Conclusion: Abdominal myomectomies overall were associated with higher fibroid weight compared to minimally invasive myomectomies. However, for fibroid specimen weights greater than 250 grams, abdominal myomectomies were not associated with greater specimen weight than with minimally invasive approaches. The largest myomectomy, in terms of fibroid weight, in this study was performed in a minimally invasive fashion. These findings contribute to the growing body of evidence supporting the feasibility and efficacy of minimally invasive myomectomies.