What is the Greatest Need for the Future of Research in Minimally Invasive Gynecologic Surgery? An Evaluation of Research Gaps and Research Excesses

Objectives: The objectives for this study were to identify research gaps and research excesses in minimally invasive gynecologic surgery (MIGS) using Levels A- and C-rated clinical practice guideline (CPG) recommendations and to determine the extent to which new and ongoing studies are adhering to guideline recommendations. Materials and Methods: This was a cross-sectional study of ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform Methods. Level A and Level C recommendations from the American Association of Gynecologic Laparoscopists' CPGs were used to constructed research questions using the Participants, Intervention, Comparator, Outcome (PICO) format. Keywords were used to develop search strings for the questions and to search public trial registries for ongoing studies in the related topics. Results: This study identified a large portion of registered MIGS research currently addresses Level C recommendations, thus these studies were deemed as having low levels of evidence. The majority of these Level C-focused trials looked at abnormal uterine bleeding in patients with submucosal leiomyomas, with a large portion of the research seeking to evaluate pharmaceutical therapies. Recommendations receiving a Level A rating were shown to have a large majority of trials despite already having high quality evidence for support, such as studies on endometrial ablation. The remaining topics for consideration were addressed less frequently, if at all. Many studies identified were listed as randomized trials, and this finding was encouraging given their potential to advance patient care. Conclusions: These findings indicate an unequal representation in active research among topics considered for the study. Establishing priorities for MIGS research along with continued support for areas needing advancement will be an important step forward for evaluating the safety and efficacy of new technologies. The current authors advocate for a systematic research prioritization process that can assist in establishing research priorities for areas with the greatest potential to improve patient care.