Does Ulipristal Acetate Affect Surgical Experience at Laparoscopic Myomectomy?

Abstract Study Objective To compare surgical experience of laparoscopic/robotic myomectomy in premenopausal patients pretreated with ulipristal acetate (UPA) with women not hormonally pretreated. Design Retrospective, multicenter cohort study of laparoscopic/robotic myomectomy procedure videos (Canadian Task Force Classification III). Setting Multiple university-affiliated tertiary care hospitals. Patients Fifty-five premenopausal women who underwent laparoscopic/robotic myomectomy for intramural fibroids and were either pretreated with 3-months of UPA or had no hormonal pretreatment. Interventions Laparoscopic/robotic myomectomy surgical videos were independently reviewed by two 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: 1) depth of myometrial incision, 2) ease of myoma-myometrium cleavage plane identification, 3) ease of myoma detachment, 4) blood loss during myoma detachment, 5) myometrial blood loss after myoma detachment, and 6) myoma consistency. Measurements and Main Results Participating surgeons submitted 55 videos of laparoscopic/robotic myomectomy procedures recorded over a 3-year period (2012 to 2015). Fifty met 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 versus 38.3 years; p = .002). There were no statistically significant differences regarding other baseline characteristics such as largest diameter of fibroid removed, number of fibroids removed, or 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 versus 13.4, p = .23). Within the six subscales, no differences were observed between the two groups. Each video was graded independently by two assessors and there was high inter-rater agreement for the total score and each subscale. Conclusion There was no difference in surgical experience for myomectomies of patients pretreated with UPA versus those without medical pretreatment.