Outcomes of laparoscopic myomectomy for large and high-order fibroids: a single-centre service evaluation
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Authors
McMurray, Rebecca
Reindorf, Maxine
Vandermolen, Brooke
Aref-Adib, Mehrnoosh
Odejinmi, Funlayo
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Issue Date
2026
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Article
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Abstract
BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.; Fibroids are common, non-cancerous growths in the uterus. People from ethnic minority backgrounds often experience larger and more numerous fibroids yet are less likely to be offered keyhole (laparoscopic) surgery, which can lead to longer recovery and higher complication rates. This study evaluated 550 patients undergoing laparoscopic myomectomy at a specialist centre in East London, UK, over a 20-year period. Patients were grouped by fibroid burden: large (>10 cm), high-order (>10 fibroids removed), both or neither. We found that ethnic minority patients generally had higher fibroid burden. While blood loss was slightly higher in patients with large or multiple fibroids, there were no differences in hospital stay or major complications across the groups.These findings suggest that laparoscopic surgery can be safely performed to remove fibroids for patients with complex fibroid disease, including those from ethnic minority backgrounds who are often excluded under current criteria. The study highlights the importance of specialist centres to ensure equitable access to minimally invasive fibroid surgery and improved outcomes for all patients.
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Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
Volume
46
Issue
1