title: Does Ulipristal Acetate Affect Surgical Experience at Laparoscopic Myomectomy?
abstract: To compare surgical experience of laparoscopic/robotic myomectomy in premenopausal patients pretreated with ulipristal acetate (UPA) with women not hormonally pretreated.
  
  
  
  A retrospective, multicenter cohort study of laparoscopic/robotic myomectomy procedure videos (Canadian Task Force Classification III).
  
  
  
  Multiple university-affiliated tertiary care hospitals.
  
  
  
  Fifty-five premenopausal women who underwent laparoscopic/robotic myomectomy for intramural myomas and were either pretreated with 3 months of UPA or had no hormonal pretreatment.
  
  
  
  Laparoscopic/robotic myomectomy surgical videos were independently reviewed by 2 gynecologists blinded to whether or not patients received pretreatment with UPA. Each procedure was scored using a novel 22-point surgical global rating tool containing 6 subscales: depth of myometrial incision, ease of myoma-myometrium cleavage plane identification, ease of myoma detachment, blood loss during myoma detachment, myometrial blood loss after myoma detachment, and myoma consistency.
  
  
  
  Participating surgeons submitted 55 videos of laparoscopic/robotic myomectomy procedures recorded over a 3-year period (2012-2015). Fifty met the inclusion criteria (25 UPA-treated patients and 25 patients without hormonal pretreatment). Patients treated with UPA were more likely to be older than patients with no medical pretreatment (mean age = 33.5 vs 38.3 years, p = .002). There were no statistically significant differences regarding other baseline characteristics such as the largest diameter of myoma removed, the number of myomas removed, or the estimated blood loss. There was no difference in the physician assessors' mean global rating score for patients with UPA pretreatment versus no pretreatment (12.4 vs 13.4, p = .23). Within the 6 subscales, no differences were observed between the 2 groups. Each video was graded independently by 2 assessors, and there was high inter-rater agreement for the total score and each subscale.
  
  
  
  There was no difference in surgical experience for myomectomies of patients pretreated with UPA versus those without medical pretreatment.
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lea
authors.initials: L
authors.lastname: Luketic
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Shirreff
authors.affiliation: Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sari
authors.initials: S
authors.lastname: Kives
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, William Osler Health System, Toronto, Ontario, Canada.
authors.forename: Ramadan
authors.initials: R
authors.lastname: El Sugy
authors.affiliation: Department of Obstetrics and Gynecology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Leyland
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Meir Jonathon
authors.initials: MJ
authors.lastname: Solnik
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: ally.murji@sinaihealthsystem.ca.
authors.forename: Ally
authors.initials: A
authors.lastname: Murji
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006176:Gynecology / Q000193:education; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007889:Leiomyoma / Q000188:drug therapy / Q000601:surgery*; D009649:Norpregnadienes / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods* / Q000706:statistics & numerical data; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000601:surgery*; D014741:Video Recording; D000078329:Workforce
chemical_list: D009649:Norpregnadienes; C555622:ulipristal acetate
keywords: Laparoscopy; Myomas; Selective progesterone receptor modulator; Surgery