Through or Below? Transumbilical Versus Low Transverse Mini-Laparotomy Incision for Fibroid Morcellation

INTRODUCTION: Laparoscopic (L-M) and robot-assisted laparoscopic myomectomy (RA-M) are minimally invasive approaches for myomectomies that often require specimen morcellation for retrieval through a mini-laparotomy incision; typically, via low transverse (LTI) or transumbilical (UI) incision. Choice of incision varies widely among surgeons, with little understanding of factors contributing to that decision. OBJECTIVE: We aim to investigate the differences in patient selection for LTI vs UI for morcellation. METHODS: Retrospective chart review was performed for 139 patients who underwent LM or RA-M with fibroid morcellation between 2013 and 2023. Data collected included patient demographics, intraoperative findings, and postoperative length of stay. Chi-square test and logistic regression analysis were performed and p-value was defined as <0.05 for statistical significance. A questionnaire was also sent out to MIGS faculty exploring factors influencing their choice of incision type. RESULTS: Out of 139 patients, 16 underwent morcellation through LTI and 123 through UI. 62.2% were Black, 25.9% White, and 11.9% were of other races. Average age was 36.6 years. Average BMI was 31.6. Mode of surgery (RA vs L), BMI, fibroid weight, operative time, estimated blood loss (EBL), and history of prior abdominal surgery were not statistically different between LTI vs UI. Higher EBL of 1u (OR=1.005, p=0.016) and longer incision length by 1 cm (OR=2.9, p=0.044) were significantly associated with a hospital stay of 1+ days. Incision type, mode of surgery, BMI, fibroid weight, and operative time were not statistically associated with length of stay. Subjectively, surgeons reported prior surgical history, personal preference, patient’s cosmetic preference, and location of midline port as contributory factors. CONCLUSIONS: BMI, mode of surgery, surgical history, and fibroid size do not seem to influence decision for type of incision for morcellation of myomas. Operative time and EBL were similar across incision types. Longer incision length and higher blood loss were significantly associated with increased length of stay.Table 1Table 2