Evidence-Based Recommendations for Referral and Consultation to a Minimally Invasive Gynecologic Surgeon: A Systematic Review

Document Type

Conference Proceeding

Publication Date


Publication Title

J Minim Invasive Gynecol


Study Objective: Minimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic pathology. To date, no formal recommendations have been made in defining a referral system for MIGS. This systematic review investigates the evidence regarding common pathologies and procedures including leiomyomatous uteri, endometriosis, and complex hysterectomies and their outcomes, and posits a basis for MIGS referral.

Design: Systematic Review.

Setting: University-Affiliated Community Hospital.

Patients or Participants: A PubMed literature search of pertinent research published within the preceding 5 years from January 2017 - Dec 2021. 1435 titles and abstracts were identified, and of these 372 full articles screened. 26 retrospective studies were eligible and included in this systematic review. Interventions: The following PubMed MeSH terms were used for literature review: Leiomyomas - fibroids, myomectomy, complications, outcomes; Endometriosis - endometriosis, minimally invasive gynecologic surgery fellowship; and Complex Hysterectomy - complex MIS, Hysterectomy, obesity, outcomes, high volume, high volume gynecologic surgeon.

Measurements and Main Results: In instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes and therefore benefit from the skills of MIGS subspecialists: Fibroids - ≥5 myomas, myoma size ≥9cm, and suspected myoma weight ≥500g; Endometriosis - presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; and Complex Hysterectomy - uteri ≥250g or 12 weeks estimated size, ≥3 prior laparotomies, obesity, and complex surgical history with suspected adhesive disease.

Conclusion: A referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.





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