Long Term Outcomes and Patient Satisfaction in Women Undergoing Myomectomy Via Laparotomy and Two Minimally Invasive Approaches: Robot-Assisted Laparoscopy and Minilaparotomy

To compare long-term outcomes and satisfaction in women undergoing myomectomy via traditional laparotomy (L), robot-assisted laparoscopy (RM) and mini-laparotomy (ML). IRB-approved mailed survey. University hospital tertiary referral center. 456 women who underwent myomectomy at the University of Michigan from 4/7/2004 through 6/18/2010 were identified (150 via L, 203 via RM, and 103 via ML). Mailed surveys were sent to 366 women whose addresses could be identified, 31 of those were returned for incorrect addresses, and 16 opted out. One hundred twenty-eight surveys were returned; 40 (L), 61 (RM) and 27 (ML). Mailed survey assessing change in symptoms, subsequent medical and surgical interventions for fibroids and general satisfaction. The response rate was 128/335 (38.2%). Mean age at the time of myomectomy was 37.6 years (range 22-55) and the mean follow-up time was 4.5 years (range 1.7-7.7), Overall, 68.2% of women reported improvement in heavy menstrual bleeding (67.6% after L, 64.2% after RM, and 78.3% after ML, p = 0.5), while 65.0% reported improvement in painful periods (64.7% after L, 56.6% after RM and 84.2% after ML, p = 0.1) and 78% had improvement in their bulk symptoms (74.2% after L, 73.9% after RM and 89.5% after ML, p = 0.4). Nine (7.1%) women subsequently underwent hysterectomy, and 8 (6.4%) women underwent another myomectomy. One hundred (78.1%) women were satisfied with their surgery (L 75.0%, RM 82.0%, ML 74.1%, p = 0.1) and 97 (80.8%) women would recommend the surgery to a friend (L 80.0%, RM 85.2%, ML 74.1%, p = 0.8). Myomectomy by each of the three surgical routes is a procedure with high satisfaction rates and improvement in symptoms. The surgical approach in this study did not confer any significant advantage for the long term outcomes studied.