The prevalence of uterine fibroids is estimated to be approximately 80%. Fibroids can be associated with abnormal uterine bleeding, pressure symptoms, and infertility. Given this high prevalence, approximately 30,000 myomectomies are performed in the United States per year. Minimally invasive approaches are preferred if feasible. The minimally invasive techniques include, laparoscopic, robot assisted, hysteroscopic, and mini laparotomy. OBJECTIVE: To discuss the multiple techniques for optimizing the use of mini-laparotomy in minimally invasive myomectomy.
We utilize intraoperative surgical video to demonstrate techniques that optimize use of the mini-laparotomy for myomectomy.
Patient’s undergoing fertility preserving, minimally invasive myomectomy at the Cleveland Clinic. The patient(s) included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites.
After the surgeon has selected to proceed with mini-laparotomy myomectomy, different techniques can be employed to optimize management. We demonstrate and discuss these techniques so that surgeons have a set of tools to tackle a fibroid uterus. These techniques include: direct palpation of the fibroids; use of a uterine manipulator to visualize the endometrial cavity; use of the uterine manipulator to aid in repair of the cavity if entered; suturing technique that avoids the endometrial cavity therefore limiting foreign body exposure and decreasing intrauterine adhesion formation; utilization of barbed suture in a layered fashion; in-situ debulking to avoid injury to fallopian tubes and other critical uterine structures; easy identification of the optimal enucleation plane; use of single hysterotomy for multiple fibroids; visualization of the “Tortuga” sign; evaluation of the abdominal cavity by using the mini laparotomy site as a port site. To limit postoperative adhesion formation, the authors place cellulose based adhesion barriers with peritoneum closure. While the need for prolonged post-operative observation can be made on a case-by-case basis, we consider this an outpatient surgery and anticipate same day discharge for our patients.
In this video we optimally perform a mini-laparotomy myomectomy and describe the techniques employed.
Mini-laparotomy myomectomy is a technique used to perform minimally invasive myomectomy. Following the discussed steps, surgeons can feel more confident in performing this method of myomectomy.

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