The gold standard access for myomectomy is laparoscopy in selected cases, including intramural and sub-serous symptomatic leiomyomas. The main contraindications concern inexperience of the surgeon, severe necrobiosis, suspected leiomyosarcoma and excessive size. The tips and tricks of the laparoscopic technique are described, specially enucleation, myometrium suture and prevention adhesions.
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