The laparoscopic myomectomy: a survey of Canadian gynaecologists

To survey all gynaecologists in Canada to determine the number who perform or offer the laparoscopic myomectomy (LM) procedure, the barriers that deter gynaecologists from performing or offering LM, and to understand the perceptions and attitudes of Canadian gynaecologists with respect to LM.

A survey was developed, pre-tested, and distributed to all 1279 obstetrician-gynaecologists on the SOGC mailing list in April 2007.

A total of 529 obstetrician-gynaecologists participated in the survey a response rate of 41.4%. Of the 485 respondents who practised gynaecology, 119 (24.5%) performed LM, but only 15 (3.1%) stated that more than 50% of their myomectomies were performed laparoscopically. Two hundred twelve gynaecologists (44.3%) admitted to having referred a patient to another gynaecologist for LM. Laparoscopic surgeons felt the principal barrier to performing LM was lack of training in the procedure (70.7%). Gynaecologists felt the principal barrier to referring to another gynaecologist for LM was their uncertainty about who offered the procedure (33%). The majority of gynaecologists believed that LM has faster recovery time. The majority of respondents, however, were unsure which procedure is superior with respect to blood loss, adhesion formation, fertility rate post-procedure, uterine rupture rate in subsequent pregnancy, and cost-effectiveness.

Despite existing evidence that indicates that LM is comparable to abdominal myomectomy with respect to complication rates and fertility, only one quarter of Canadian gynaecologists who responded to this survey performed the procedure. Barriers to performing LM included lack of training and barriers to referral included uncertainty about who offered the procedure.