Comparing Aggregate Fibroid Weight in Abdominal Versus Minimally Invasive Myomectomies in a Community Health System

Study objective: To compare the aggregate fibroid specimen weights between abdominal and minimally invasive (MI) myomectomies to determine whether fibroid burden significantly impacts surgical approach to myomectomy.

Design: Retrospective cohort study; INTERVENTIONS: Comparison of aggregate fibroid specimen weights between abdominal and MI myomectomies SETTING: Community health care system.

Patients: 281 patients undergoing abdominal and MI myomectomies between March 2018 and December 2023.

Measurements/main results: A total of 281 patients underwent a myomectomy in our health system between 2018 and 2023. One-hundred and twenty-four (44.2%) patients had aggregate fibroid weights less than 250 grams, sixty-seven (23.8%) patients had a fibroid weight between 250 and 500 grams, and ninety (32.0%) patients had fibroid weights greater than 500 grams. Abdominal myomectomies had a higher percentage of fibroids with aggregate weight greater than 500 grams (48.5% vs 16.6%), and were associated with higher fibroid specimen weights overall (median 482 grams vs 204 grams for MI). However, after adjusting for age, BMI, race, and insurance and comparing median weights between the 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.

Conclusion: Abdominal myomectomies overall were associated with a higher fibroid weight compared to MI myomectomies. However, when looking at myomectomies with aggregate fibroid specimen weights of 250 grams or greater, abdominal myomectomies were not associated with greater specimen weight than with MI approaches. This study supports the growing utilization of minimally invasive approaches for myomectomies in patients with large fibroid burden.