Outcomes of laparoscopic myomectomy for large and high-order fibroids: a single-centre service evaluation
Ethnic minority patients experience a higher uterine fibroid disease burden and reduced access to minimally invasive myomectomy. Restrictive selection criteria may disproportionately exclude these patients from laparoscopic surgery. This was a prospective service-evaluation database analysed retrospectively, including all conventional (non-robotic) laparoscopic myomectomies performed between January 2004 and December 2024 at a single UK university hospital. Primary outcomes were estimated blood loss (EBL), length of hospital stay (LOS) and operating time. Secondary outcomes were blood transfusion rate, conversion to laparotomy and analysis of fibroid burden by ethnicity. Outcomes were compared between patients with large fibroids (>10 cm), high-order fibroids (>10 fibroids removed), both and neither. We performed inferential descriptive statistics using SPSS v27 (SPSS Inc., Chicago, IL). Among 550 patients, 164 had large fibroids, 30 high-order fibroids, 18 both and 338 neither. Ethnic minority patients represented 77%, 93%, 89% and 72% of these groups, respectively. Mean EBL was higher in large fibroid (345 mL) and combined groups (483 mL) compared with neither (211 mL), without associated increases in transfusion, conversion to laparotomy, or LOS. Black African and Black Caribbean patients had greater fibroid burden and higher blood loss than Caucasian patients, reflecting disease severity rather than ethnicity as an independent determinant of outcome. In a specialist setting, laparoscopic myomectomy is feasible and safe for patients with large and/or multiple fibroids, including those from ethnic minority backgrounds with higher disease burden. Expansion of access within appropriately resourced centres may help reduce inequities in fibroid care.