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Details

Name
12373 - Pregnancy Outcomes Following Minimally Invasive Laparoscopic and Robot-Assisted Laparoscopic Myomectomy: A Cross-Sectional Analysis
Presenting Author
Briana Baxter
Affiliation
Columbia University Medical Center
Abstract
Study Objective: To study pregnancy outcomes in women undergoing robotic and laparoscopic myomectomy.

Design: Cross-sectional study.

Setting: Academic tertiary referral center, Department of Obstetrics & Gynecology, New York, NY, United States.

Patients or Participants: Patients that underwent minimally invasive myomectomy between 2015 and 2021 and agreed to participate.

Interventions: The primary outcome was pregnancy and livebirth rates after minimally invasive myomectomy. Secondary outcomes were mode of delivery, obstetric complications, use of ART, and need for additional treatment.

Measurements and Main Results: 856 patients underwent minimally invasive myomectomy between 2015 and 2021. Of them,101 completed an electronic survey assessing pregnancy outcomes. The predominant surgical route was robotic myomectomy 88.1%(95%CI:81.8,94.4) followed by combined robotic and hysteroscopic myomectomy 10.9%(95% CI:4.8,17.0). The average age was 37.2 ± 4.9 and average BMI 26.2 ± 4.8. Reported race was 43.6% White, 31.7% Black and 17.8% Asian. 12.9% were of Hispanic ethnicity. Median number of fibroids removed was 3.0(1.0-5.0) and median weight 131.5(68.5.0-216.0). Most were nulliparous 82.0% (95% CI:74.5,89.5) and had preoperative MRI 81.2%(95%CI:73.6 88.8). Ultimately, 53.5% (95% CI:43.7, 63.2) (54/101) conceived and 90.7% (95% CI:83.0 98.5) (49/54) delivered a liveborn infant. Cesarean birth was the predominant mode of delivery 93.9% (95% CI: 87.2,100) and 79.6% (95% CI: 68.3, 90.9) delivered at term. The median time to pregnancy was 7.0 months (2.0-15.0) and 51% (95% CI: 37.0, 65.0) used IVF to get pregnant. Of the 47 patients who did not conceive, 17 or 36.2% (95% CI: 22.4,39.9) attempted to conceive, and 58.8% (95% CI:35.4, 82.2) remained unsuccessful despite utilizing IVF/ART. Finally, 9.9% (95% CI: 4.1, 15.7) required further treatment after surgery including additional myomectomy, radiofrequency ablation and hysterectomy.

Conclusion: Pregnancy and livebirth rates after minimally invasive myomectomy are promising, however some encounter challenges conceiving postoperatively. Continued investigation is needed to improve fertility sparing and optimizing strategies during myomectomy.

Authors
Baxter, BL*1, Angley, M2, Falako, SE3, Gopal, TS3, Masson, CF3, Advincula, A4, Kim, JHJ5. 1Division of Gynecologic Specialty Surgery, Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, NY; 2Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; 3Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; 4Columbia Irving Medical Center - New York Presbyterian Hospital, New York, NY; 5Columbia University Medical Center, New York, NY
Primary Category
Fibroids
Secondary Category
Reproductive Medicine
Sponsorship Level
Virtual Poster
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