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Minimally invasive surgery for uterine fibroid removal is gaining popularity, but racial and ethnic disparities and gaps by socioeconomic status still exist, according to a retrospective study based in California.

Compared with white women, Black women were less likely to undergo minimally invasive surgery (OR 0.88, 95% CI 0.81-0.95), as were Hispanic women (OR 0.74, 95% CI 0.69-0.79), reported Andrea Molina, MD, of Cedars-Sinai Medical Center in Los Angeles, during a virtual presentation at the American Association of Gynecologic Laparoscopists annual meeting.

Patients with Medicaid were about 80% less likely to undergo a minimally invasive procedure than those who were privately insured (OR 0.22, 95% CI 0.21-0.24). Additionally, surgeries performed at academic centers had 50% greater odds of being minimally invasive (OR 1.50, 95% CI 1.42-1.58).

"While the majority of myomectomies in the state of California are performed via the abdominal approach, the rate of minimally invasive myomectomy is increasing over time [from 3.7% in 2005 to 38.9% in 2018], and is approaching the rate of abdominal myomectomy," Molina noted.

However, the lower rates of minimally invasive procedures among women of color and those with public insurance highlight disparities in surgical treatment of uterine fibroids, she added. "Further studies are needed to further delineate factors affecting surgical approach to myomectomy, and to determine how to address disparities in access to minimally invasive myomectomy."

The researchers aimed to evaluate trends in the operative approach for myomectomy, as well as patient and facility factors with both open and minimally invasive surgeries. They analyzed patients who underwent a myomectomy from 2005 to 2018, including surgeries performed at all non-VA facilities in California. Because there were very few minimally invasive myomectomies performed before 2012, the comparative analysis in this study includes all myomectomies after that year.

Overall, Molina and colleagues identified nearly 72,000 patients who underwent myomectomies, 15% of which were minimally invasive.

Patients who underwent a minimally invasive myomectomy were more likely to be younger than those who underwent an open procedure (39 vs 45 years), and were less likely to have comorbidities, such as hypertension and diabetes, but more likely to be obese.

Molina acknowledged that this study was unable to evaluate for fibroid burden, and could not differentiate between robotic and laparoscopic surgery approaches.

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