Minimally invasive myomectomy (MIM), defined as laparoscopic or robotic myomectomy, has proven clinical benefits over traditional laparotomy and mini-laparotomy, including decreased postoperative pain, faster postoperative recovery [1, 2, 3, 4], and shorter hospital stay [5]. Additionally, open myomectomy may be associated with higher rate of cesarean section compared to laparoscopic myomectomy [6].

Limited studies have evaluated the feasibility and safety of MIM for large and/or multiple fibroids. One study evaluated the safety of laparoscopic myomectomy but most myomas were less than 5cm and most patients had two or fewer fibroids removed [7]. Another study showed the feasibility of MIM with large fibroids but reported higher rate of complications with a dominant fibroid greater than 12cm [8]. Gunnala et al also reported increased operative time and estimated blood loss in myomectomy with a single large fibroid > 9cm, but same day discharge was feasible [9]. However, there are no studies evaluating the feasibility, safety, and surgical outcomes of MIM for higher number of fibroids.

The objective of this study is to investigate the feasibility for higher order MIM, defined in this study as removing 10 or more fibroids. We hypothesize that MIM for higher order fibroids performed by high volume surgeons is feasible.