When should open surgery be preferred for uterine myomas?-a narrative review.

Background and Objective: Uterine leiomyomas are the most common benign tumors of the female genital tract, affecting approximately 20-40% of women of reproductive age. Clinically, they may present with heavy menstrual bleeding, pelvic pain, pressure symptoms, and infertility. There are different treatment modalities depending on the patient's age and expectations, uterine size, the size and localization of the myoma(s), etc. Myomectomy is a key surgical option, particularly for patients who wish to preserve fertility or maintain the uterus. Although minimally invasive approaches are increasingly used, open (abdominal) myomectomy remains a preferred technique for large, numerous, or deeply located fibroids. The aim of this article is to investigate in which patients open abdominal myomectomy should be preferred. In this context, we will discuss the advantages and disadvantages of the surgical treatment methods of fibroids in patients. Methods: PubMed, Web of Science, and Google Scholar were queried using pertinent keywords to retrieve relevant studies with a particular focus on open abdominal myomectomy, mini-laparotomy, laparoscopic and hysteroscopic myomectomy for uterine fibroids. Key Content and Findings: Myomectomy with laparotomy seems to be more appropriate in the presence of an intramural myoma >10-12 cm in size or multiple myomas (≥4) at different sites in the uterus, requiring numerous incisions. Conclusions: Treatment preferences depend on the patient's age and desire to preserve fertility, as well as the clinical presentation of the myoma such as the size, number and location of fibroids, and also the surgical experience of the gynecologist.