Division of Minimally Invasive Gynecologic Surgery, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (Drs. Leaf, Borahay, Frost, Patzkowsky, Wang, Wu, and Simpson).
Johns Hopkins School of Medicine, Baltimore, MD (Lombardo).
J Minim Invasive Gynecol. 2024 Oct;31(10):870-874. doi: 10.1016/j.jmig.2024.04.024. Epub 2024 May 3.
To investigate perioperative outcomes of minimally invasive higher order myomectomy as defined by removal of 10 or more fibroids.
A retrospective cohort study between January 2018 and December 2022.
A tertiary academic medical center.
Women who underwent minimally invasive myomectomy via laparoscopic or robotic approach.
Surgical intervention in the form of minimally invasive myomectomy.
A total of 735 women met inclusion criteria of whom 578 had fewer than 10 fibroids removed, and 157 patients had 10 or more removed (average number of fibroids removed 3.8 vs 14.7, p <.001; specimen's weight 317.4 g vs 371.0 g, p = .07). Body mass index was similar in both groups (p = .66) and patients with higher order myomectomy were more likely to have a history of myomectomy (12.0% vs 26.8%, p <.001). The average estimated blood loss (EBL) was 246 mL vs 470 mL in each group (p <.001). There were no significant differences in packed red blood cell transfusion (1.0% vs 0.6%, p = .65), conversion to laparotomy (0.5% vs 0.6%, p = .86), or complications including visceral injury, wound complication, venous thromboembolism, ileus, or readmission (5.9% vs 4.5%, p = .49). The hospital length of stay was similar in both groups (0.5 days vs 0.5 days, p = .63). On linear regression analysis, after adjusting for specimen's weight, operative time, and history of myomectomy, EBL remained significantly higher in patients with 10 or more fibroids removed (p = .02).
EBL is increased in higher order myomectomy; however, blood transfusions, conversion to laparotomy, complication rates, and length of hospital stay did not differ compared with patients with fewer than 10 fibroids removed, highlighting the feasibility of minimally invasive higher order myomectomy.
研究定义为切除 10 个或更多肌瘤的微创高级子宫肌瘤切除术的围手术期结果。
2018 年 1 月至 2022 年 12 月的回顾性队列研究。
一家三级学术医疗中心。
接受腹腔镜或机器人微创子宫肌瘤切除术的女性。
微创手术的形式为微创子宫肌瘤切除术。
共有 735 名女性符合纳入标准，其中 578 名女性切除的肌瘤少于 10 个，157 名女性切除的肌瘤为 10 个或更多（切除的肌瘤平均数量分别为 3.8 个和 14.7 个，p<0.001；标本重量分别为 317.4g 和 371.0g，p=0.07）。两组的体重指数相似（p=0.66），高级子宫肌瘤切除术患者更有可能有子宫肌瘤切除术史（12.0% vs.26.8%，p<0.001）。每组的平均估计失血量（EBL）分别为 246mL 和 470mL（p<0.001）。两组在输红细胞悬液（1.0% vs.0.6%，p=0.65）、转为剖腹手术（0.5% vs.0.6%，p=0.86）或并发症（包括内脏损伤、伤口并发症、静脉血栓栓塞、肠梗阻或再入院）（5.9% vs.4.5%，p=0.49）方面无显著差异。两组的住院时间相似（0.5 天 vs.0.5 天，p=0.63）。在线性回归分析中，在调整标本重量、手术时间和子宫肌瘤切除术史后，切除 10 个或更多肌瘤的患者 EBL 仍显著升高（p=0.02）。
高级子宫肌瘤切除术的 EBL 增加；然而，与切除少于 10 个肌瘤的患者相比，输血、转为剖腹手术、并发症发生率和住院时间没有差异，突出了微创高级子宫肌瘤切除术的可行性。
