title: Temporal trends in minimally invasive myomectomy before and after the US Food and Drug Administration recommendation against electric morcellation.
abstract: OBJECTIVE
  To investigate the temporal trends in minimally invasive myomectomy at one reproductive medicine center before and after the US Food and Drug Administration (FDA) recommendation against electric morcellation.
  
  
  METHODS
  A retrospective chart review was undertaken of patients undergoing minimally invasive myomectomy between April 1, 2012, and April 30, 2016, at a center in New York. Temporal trends in laparoscopic myomectomy (LM), robot-assisted laparoscopic myomectomy (RAM), and laparoscopically assisted myomectomy (LAM), and intraoperative and postoperative outcomes before and after the April 2014 recommendation were compared.
  
  
  RESULTS
  Minimally invasive myomectomy was performed in 73 patients. No difference was noted in the rates of minimally invasive myomectomy 2 years before (35/74 [47.3%]) and after (38/79 [48.1%]) the FDA's recommendation. The ratio of abdominal to minimally invasive myomectomy remained relatively constant before (68/59=1.15) and during the study period (80/73=1.10). There was a significant decrease in LM and RAM and a corresponding rise in LAM immediately after the recommendation (P<0.001).
  
  
  CONCLUSIONS
  The rates of minimally invasive myomectomy before and after the FDA's recommendation did not differ, indicating that technical modifications to laparoscopic technique can allow surgeons to offer minimally invasive myomectomy to patients with symptomatic leiomyomas.
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Nigel
authors.initials: N
authors.lastname: Pereira
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Frankel
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Hutchinson
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Hency H
authors.initials: HH
authors.lastname: Patel
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Cheri
authors.initials: C
authors.lastname: Mostisser
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Rony T
authors.initials: RT
authors.lastname: Elias
mesh_terms: D000328:Adult; D004598:Electrosurgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D000069577:Morcellation / Q000379:methods; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014481:United States; D014486:United States Food and Drug Administration; D063186:Uterine Myomectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000601:surgery*
keywords: Food and Drug Administration; Laparoscopy; Minimally invasive surgery; Morcellation; Myomectomy; Robotic surgery