{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:19:07Z","timestamp":1792106347476,"version":"4.4.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Myomectomy has evolved from open laparotomy to laparoscopy, hysteroscopy, VNOTES and robotic myomectomy. The surgical approach in doing myomectomy depends on the type and location of the myoma and the surgeon\u2019s expertise. Minimally invasive surgery has been the preferred approach due to the benefit of shorter hospital stay, lesser postoperative pain, earlier recovery, minimal blood loss and the cosmetic appearance of the scar. The success of this procedure depends on the incision technique, enucleation, and blood loss prevention by using hemostatic techniques and suturing techniques. Performing myomectomy for a large uterine myoma is a laparoscopic challenge; however, with the use of Lee-Huang point (midpoint between umbilicus and xiphoid) as the primary insertion and camera port, one can easily navigate thru the abdominal cavity in case the uterus is huge obscuring the umbilical port. Laparoscopic Myomectomy can be safely and efficiently performed by experienced laparoscopic surgeons regardless of myoma size, number and location. Removal of large myoma specimen from the abdominal cavity through the laparoscope became a challenge after the use of power morcellator was abandoned. To overcome this problem, the large myoma is placed inside an Endo bag and its edges brought extracorporeally through the port site. The myoma is incised in a C-manner using a scalpel to reduce the size. Myoma can also be removed using in-bag power morcellation. Fertility preservation is the long-term aim of doing myomectomy instead of hysterectomy in the management of leiomyoma aside from alleviating symptoms of abnormal uterine bleeding, urinary frequency and abdominal pain.<\/jats:p>","DOI":"10.4103\/gmit.gmit_152_23","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T07:03:29Z","timestamp":1721372609000},"page":"146-153","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Myomectomy: Choosing the Surgical Approach \u2013 A Systematic Review"],"prefix":"10.4103","volume":"13","author":[{"given":"Jhanice Sangdaan","family":"Paredes","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan"},{"name":"Department of Obstetrics and Gynecology, Luis Hora Memorial Regional Hospital, Bauko, Mountain Province, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chyi-Long","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan"},{"name":"Chang Gung University School of Medicine, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng Teng","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mahkota Medical Centre, Melaka, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"key":"R1-20240830","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.13102","article-title":"Epidemiology and management of uterine fibroids","volume":"149","author":"Giuliani","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"R2-20240830","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1590\/S1807-59322007000300002","article-title":"The history of myomectomy at the medical school of university of S\u00e3o Paulo","volume":"62","author":"Bozini","year":"2007","journal-title":"Clinics (Sao Paulo)"},{"key":"R3-20240830","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1111\/1471-0528.14936","article-title":"The evolution of myomectomy: From laparotomy to minimally invasive surgery","volume":"125","author":"Bortoletto","year":"2018","journal-title":"BJOG"},{"key":"R4-20240830","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1089\/gyn.2021.0111","article-title":"The history of myomectomy","volume":"37","author":"Miller","year":"2021","journal-title":"J Gynecol Surg"},{"key":"R5-20240830","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/j.jmig.2021.09.341","article-title":"The true fibroid map: Correlating preoperative MRI and intraoperative findings","volume":"28","author":"Chitkara","year":"2021","journal-title":"J Minim Invasive Gynecol"},{"key":"R6-20240830","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/s12905-020-01113-3","article-title":"Blood loss from transverse versus longitudinal uterine incision in abdominal myomectomy: A randomized controlled trial","volume":"20","author":"Elguindy","year":"2020","journal-title":"BMC Womens Health"},{"key":"R7-20240830","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.3390\/medicina58111627","article-title":"Hysteroscopic myomectomy","volume":"58","author":"Lasmar","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"R8-20240830","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.gmit.2016.12.004","article-title":"Useful technique for submucous myomectomy under direct transcervical resectoscope observation","volume":"6","author":"Hoshino","year":"2017","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R9-20240830","doi-asserted-by":"crossref","first-page":"238","DOI":"10.4103\/gmit.gmit_9_22","article-title":"Oral gonadotropin-releasing hormone antagonist relugolix has the same effect as gonadotropin-releasing hormone agonist injections in terms of preparation for transcervical resection myomectomy","volume":"11","author":"Ito","year":"2022","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R10-20240830","first-page":"161","article-title":"The 19 Fr. Intrauterine Bigatti Shaver (IBS\u00ae): A clinical and technical update","volume":"10","author":"Bigatti","year":"2018","journal-title":"Facts Views Vis Obgyn"},{"key":"R11-20240830","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s10397-010-0634-8","article-title":"IBS\u00ae Integrated Bigatti Shaver, an alternative approach to operative hysteroscopy","volume":"8","author":"Bigatti","year":"2011","journal-title":"Gynecol Surg"},{"key":"R12-20240830","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4103\/GMIT.GMIT_94_19","article-title":"The association between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who previously underwent one-step hysteroscopic myomectomy","volume":"9","author":"Kasuga","year":"2020","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R13-20240830","article-title":"In-bag manual versus uncontained power morcellation for laparoscopic myomectomy","volume":"5","author":"Zullo","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"R14-20240830","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.gmit.2014.02.001","article-title":"Laparoscopic myomectomy \u2013 The gold standard","volume":"3","author":"Herrmann","year":"2014","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R15-20240830","doi-asserted-by":"crossref","first-page":"221","DOI":"10.4103\/gmit.gmit_146_21","article-title":"Influence of uterine cavity breach in laparoscopic myomectomy on the risk of obstetric complications","volume":"11","author":"Wada","year":"2022","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R16-20240830","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1055\/s-0039-3401027","article-title":"Laparoscopic myomectomy","volume":"6","author":"Andou","year":"2020","journal-title":"Surg J (N Y)"},{"key":"R17-20240830","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/j.fertnstert.2018.12.011","article-title":"Surgical outcomes after uterine artery occlusion at the time of myomectomy: Systematic review and meta-analysis","volume":"111","author":"Sanders","year":"2019","journal-title":"Fertil Steril"},{"key":"R18-20240830","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4103\/GMIT.GMIT_10_21","article-title":"A video article: The laparoscopic uterine artery occlusion in combination with myomectomy for uterine myoma","volume":"11","author":"Ai","year":"2022","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R19-20240830","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.jmig.2022.08.009","article-title":"Laparoscopic triple-tourniquet constriction: A convenient way for minimizing blood loss during myomectomy","volume":"29","author":"Kuo","year":"2022","journal-title":"J Minim Invasive Gynecol"},{"key":"R20-20240830","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.jmig.2014.08.780","article-title":"AAGL advancing minimally invasive gynecology worldwide: Statement to the FDA on power morcellation","volume":"21","author":"Brown","year":"2014","journal-title":"J Minim Invasive Gynecol"},{"key":"R21-20240830","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S1074-3804(05)60565-8","article-title":"A new portal for gynecologic laparoscopy","volume":"8","author":"Lee","year":"2001","journal-title":"J Am Assoc Gynecol Laparosc"},{"key":"R22-20240830","doi-asserted-by":"crossref","first-page":"63","DOI":"10.14712\/18059694.2020.18","article-title":"Robotic management of fibroids: Discussion of use, criteria and advantages","volume":"63","author":"Gkegkes","year":"2020","journal-title":"Acta Medica (Hradec Kralove)"},{"key":"R23-20240830","first-page":"e30569","article-title":"Robotic surgery: The future of gynaecology","volume":"14","author":"Chandrakar","year":"2022","journal-title":"Cureus"},{"key":"R24-20240830","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1080\/13645706.2018.1442349","article-title":"Robotic-assisted versus laparoscopic and abdominal myomectomy for treatment of uterine fibroids: A meta-analysis","volume":"27","author":"Wang","year":"2018","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"R25-20240830","doi-asserted-by":"crossref","first-page":"179","DOI":"10.4103\/GMIT.GMIT_62_18","article-title":"Transvaginal natural orifice transluminal endoscopic surgery myomectomy followed by hysterectomy","volume":"9","author":"Wasinghon","year":"2020","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R26-20240830","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.gmit.2017.02.005","article-title":"Subtotal hysterectomy by natural orifice transluminal endoscopic surgery","volume":"6","author":"Lee","year":"2017","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R27-20240830","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4103\/GMIT.GMIT_87_18","article-title":"Bladder safety during natural orifice transluminal endoscopic surgery hysterectomy in the patients with extensive vesicouterine adhesion","volume":"8","author":"Tantitamit","year":"2019","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R28-20240830","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.fertnstert.2017.09.009","article-title":"Transvaginal natural-orifice transluminal endoscopic surgery: A new approach to myomectomy","volume":"109","author":"Baekelandt","year":"2018","journal-title":"Fertil Steril"},{"key":"R29-20240830","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.fertnstert.2022.05.009","article-title":"Robotic vaginal natural orifice transluminal endoscopic myomectomy","volume":"118","author":"Sunkara","year":"2022","journal-title":"Fertil Steril"},{"key":"R30-20240830","article-title":"Surgical approach to hysterectomy for benign gynaecological disease","volume":"8","author":"Pickett","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"R31-20240830","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1097\/AOG.0000000000002108","article-title":"Committee opinion no. 701 summary: Choosing the route of hysterectomy for benign disease","volume":"129","year":"2017","journal-title":"Obstet Gynecol"},{"key":"R32-20240830","doi-asserted-by":"crossref","DOI":"10.4293\/JSLS.2018.00030","article-title":"Symptoms and health quality after laparoscopic and robotic myomectomy","volume":"22","author":"Takmaz","year":"2018","journal-title":"JSLS"},{"key":"R33-20240830","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/jog.13519","article-title":"Recurrence of uterine myoma after myomectomy: Open myomectomy versus laparoscopic myomectomy","volume":"44","author":"Kotani","year":"2018","journal-title":"J Obstet Gynaecol Res"},{"key":"R34-20240830","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12893-016-0124-7","article-title":"The indication and curative effect of hysteroscopic and laparoscopic myomectomy for type II submucous myomas","volume":"16","author":"Wang","year":"2016","journal-title":"BMC Surg"},{"key":"R35-20240830","doi-asserted-by":"crossref","first-page":"2930","DOI":"10.3390\/jcm10132930","article-title":"The number of myomas is the most important risk factor for blood loss and total operation time in robotic myomectomy: Analysis of 242 cases","volume":"10","author":"Lee","year":"2021","journal-title":"J Clin Med"},{"key":"R36-20240830","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.jmig.2018.10.022","article-title":"Perioperative outcomes of myomectomy for extreme myoma burden: Comparison of surgical approaches","volume":"26","author":"Jansen","year":"2019","journal-title":"J Minim Invasive Gynecol"},{"key":"R37-20240830","doi-asserted-by":"crossref","first-page":"01","DOI":"10.3389\/fsurg.2022.1013918","article-title":"Transvaginal natural orifice endoscopic surgery for myomectomy: Can it be a conventional surgery?","volume":"9","author":"Hou","year":"2022","journal-title":"Front Surg"},{"key":"R38-20240830","doi-asserted-by":"crossref","first-page":"6","DOI":"10.4103\/GMIT.GMIT_21_19","article-title":"The significant risk factors of intra-operative hemorrhage during laparoscopic myomectomy: A systematic review","volume":"9","author":"Sleiman","year":"2020","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R39-20240830","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jmig.2008.01.009","article-title":"Laparoscopic myomectomy: Do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy?","volume":"15","author":"Sinha","year":"2008","journal-title":"J Minim Invasive Gynecol"},{"key":"R40-20240830","doi-asserted-by":"crossref","first-page":"e0256772","DOI":"10.1371\/journal.pone.0256772","article-title":"Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women","volume":"16","author":"Lin","year":"2021","journal-title":"PLoS One"},{"key":"R41-20240830","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s10397-014-0842-8","article-title":"The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis","volume":"11","author":"Claeys","year":"2014","journal-title":"Gynecological Surgery"},{"key":"R42-20240830","doi-asserted-by":"crossref","first-page":"101843","DOI":"10.1016\/j.jogoh.2020.101843","article-title":"Risk of uterine rupture after myomectomy by laparoscopy or laparotomy","volume":"49","author":"Gil","year":"2020","journal-title":"J Gynecol Obstet Hum Reprod"}],"container-title":["Gynecology and Minimally Invasive Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/gmit.gmit_152_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:56:17Z","timestamp":1787838977000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/gmit.gmit_152_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/gmit.gmit_152_23","relation":{},"ISSN":["2213-3070","2213-3089"],"issn-type":[{"value":"2213-3070","type":"print"},{"value":"2213-3089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]},"assertion":[{"value":"2023-12-09","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}