Does Ulipristal Acetate Affect Surgical Experience at Laparoscopic Myomectomy?

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Reproductive Medicine

Background:

• Uterine fibroids (myomas) are common in premenopausal women.
• Hormonal pretreatment aims to reduce fibroid size and vascularity before myomectomy.
• Ulipristal acetate (UPA) is a selective progesterone receptor modulator used for fibroid management.

Purpose of the Study:

• To compare the surgical experience of laparoscopic/robotic myomectomy in premenopausal patients pretreated with ulipristal acetate (UPA) versus those without hormonal pretreatment.
• To evaluate the impact of UPA pretreatment on surgical outcomes and procedural ease.

Main Methods:

• Retrospective, multicenter cohort study analyzing 50 laparoscopic/robotic myomectomy surgical videos.
• Procedures were independently reviewed by two blinded gynecologists using a novel 22-point surgical global rating tool.
• The tool assessed myometrial incision depth, cleavage plane identification, myoma detachment ease, and blood loss.

Main Results:

• Fifty premenopausal women (25 UPA-treated, 25 untreated) underwent myomectomy.
• No statistically significant differences were found in the mean global rating scores between UPA-treated and untreated groups (12.4 vs 13.4, p=0.23).
• No differences were observed in any of the six subscale scores, including myometrial incision depth, ease of detachment, and blood loss.

Conclusions:

• Pretreatment with ulipristal acetate (UPA) does not significantly alter the surgical experience or outcomes of laparoscopic/robotic myomectomy.
• Surgical performance metrics, including ease of procedure and blood loss, were comparable between UPA-treated and untreated patients.
• These findings suggest UPA pretreatment does not negatively impact the technical aspects of minimally invasive myomectomy.