title: Feasibility, Safety, and Prediction of Complications for Minimally Invasive Myomectomy in Women With Large and Numerous Myomata.
abstract: To assess perioperative outcomes and identify predictors of complications for minimally invasive surgery (MIS) myomectomy in a cohort of women with large and numerous myomata.
  
  
  
  Case-control study (Canadian Task Force classification II-2).
  
  
  
  Academic tertiary care medical center.
  
  
  
  Women undergoing MIS myomectomy performed by 3 high-volume surgeons between April 2011 and December 2014.
  
  
  
  Characteristics were compared between women who experienced complications and those who did not. Factors predictive of complications were then identified.
  
  
  
  A total of 221 women underwent an MIS myomectomy, 47.5% via a laparoscopic approach and 52.5% via robotic surgery. The mean ± SD specimen weight was 408.1 ± 384.9 g, uterine volume was 586.1 ± 534.1 cm3, dominant myoma diameter was 9.6 ± 5.1 cm, and number of myomata removed was 4.5 ± 4.1. The most common complications were hemorrhage >1000 mL (8.6%) and blood transfusion (4.1%). The conversion rate was 1.8%. A dominant myoma diameter of ≥12 cm and a uterine volume of ≥750 cm3increased the odds of complications (odds ratio [OR], 7.44; 95% confidence interval [CI], 2.03-31.84; p = .004 and OR, 6.15; 95% CI, 1.55-30.02; p = .014 respectively). A receiver operating characteristic curve considering dominant myoma diameter and uterine volume had an area under the curve of 0.81. A combination of dominant myoma diameter of ≥10 cm and uterine volume of 600 cm3predicted complications with 79% sensitivity and 79% specificity.
  
  
  
  Our cohort had large and numerous myomata with high specimen weights, but complications were comparable to those reported in previous studies of MIS myomectomy with less complex pathology. Hemorrhage and transfusion accounted for the majority of complications, and a combination of dominant myoma diameter and uterine volume was predictive of complications. Both factors can be easily defined before surgery and may be used to guide patient counseling, referrals, and implementation of preventative measures for hemorrhage and transfusion.
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: mvvargas@mfa.gwu.edu.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Vargas
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Gaby N
authors.initials: GN
authors.lastname: Moawad
authors.affiliation: Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
authors.forename: Cem
authors.initials: C
authors.lastname: Sievers
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Jessica
authors.initials: J
authors.lastname: Opoku-Anane
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Cherie Q
authors.initials: CQ
authors.lastname: Marfori
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Paul
authors.initials: P
authors.lastname: Tyan
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: James K
authors.initials: JK
authors.lastname: Robinson
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007889:Leiomyoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014481:United States / Q000453:epidemiology; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery
keywords: Complications; Laparoscopy; Minimally invasive surgery; Myomata; Myomectomy; Predictors; Robotic surgery