ASSESSING BLOOD LOSS IN ROBOTIC VERSUS ABDOMINAL MYOMECTOMY: THE IMPACT OF TRANEXAMIC ACID, VASOPRESSIN, AND MISOPROSTOL

Objective: Uterine fibroids are the most common symptomatic neoplasm in women and occur in 70% of women. Myomectomy is performed for women with symptomatic uterine fibroids who desire to retain future fertility. There are medications that can help reduce blood loss during a myomectomy. Our goal is to evaluate the effectiveness of combining pitressin, tranexamic acid (TXA), and/or misoprostol in reducing estimated blood loss (EBL) during abdominal and robotic myomectomies. Methods: A multi-site retrospective chart review was conducted on 171 patients who underwent myomectomy (Mage = 36.9; 17.4% White, 48.3% Black, 24.4% Hispanic, 9.9% Other Races). Patients were stratified based on type of procedure (robotic or abdominal). Use of pharmacologic adjunct medications to reduce blood loss (Pitressin, Cytotec, and TXA) were dichotomized to assess the effects of 3-Medication Combination compared to all other medication combinations (Pitressin only, Pitressin and Cytotec, or Pitressin and TXA). Univariate comparisons (Independent t-tests and Chi-Square tests of Independence) were conducted on demographics, comorbidities, hemoglobin levels, EBL, number, type, and size of fibroids. Results: Patients in the Robotic group (n = 80) who received the 3-Medication Combination (n = 60) had a significantly higher number of fibroids (6.6 vs 3.1, p = .005) and larger proportion of intramural fibroids (86.4% vs 61.1%, p = .036) compared to the patients who received other medication combinations (n = 20). There was no significant difference in EBL between the two medication groups undergoing Robotic myomectomy. Patients in the Abdominal myomectomy group (n = 91) in the 3-Medication Combination group (n = 28) had a significantly larger number of fibroids (11.2 vs 5.7, p = .037), higher proportion of intramural fibroids (96.3% vs 76.7%), and lower pre-operative hemoglobin levels (11.0 vs 12.2) compared to the other medication combination group (n = 63). Further, the patients undergoing Abdominal myomectomy with the 3-Medication Combination experienced significantly higher levels of EBL (387.9ml vs 183.3ml; p = .016) as compared to the other medication combination group. Conclusion: We reviewed 171 patients who underwent Robotic or Abdominal myomectomies to compare whether a 3 medication combination versus other medication combinations can help reduce blood loss. In robotic cases there was no significant difference in EBL between the two groups undergoing robotic myomectomy. In the abdominal myomectomy group, the 3 drug combination group had larger number of fibroids, more intramural fibroids, and a significantly higher EBL compared to the other drug combination. Overall the 3 drug combination had similar blood loss in robotic cases but appears to be less effective in abdominal myomectomy cases. We cannot say if the 3 drug combination used in abdominal myomectomies were in response to hemorrhage. We can suggest further randomized studies for the administration of prophylactic 3 drug combination in abdominal myomectomies in the case of higher disease burden, complexity of case, and risk of potential hemorrhage.