***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Evaluation of : Palombo S , Zupi E , Russo T et al. : A multicentric r and omized , controlled study comparing laparoscopic versus minilaparotomic myomectomy : short-term outcomes . Fertil . Steril . ( 2007 ) ( In Press ) [ 1 ] . There has been significant debate regarding the best route to myomectomy in symptomatic and infertile women . In this study , 136 premenopausal women wishing to conceive were r and omly allocated to two groups and these were compared . The patients were assigned to one of the surgical procedures ( i.e. , laparoscopic or minilaparotomic ) . Fibroid enucleation and suturing times were significantly shorter after minilaparotomic myomectomy , whereas the degree of surgical difficulty was significantly higher when using laparoscopic myomectomy . The surgical results were significantly influenced by specific investigational centers involved , and also by fibroid dimension and localization . This last variable was the strongest predictor of surgical outcome OBJECTIVE To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive . DESIGN R and omized controlled trial . SETTING Departments of obstetrics and gynecology of the universities of Catanzaro , Rome , and Florence , Italy . PATIENT(S ) One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility . INTERVENTION(S ) Laparoscopic and minilaparotomic myomectomy . MAIN OUTCOME MEASURE(S ) Pregnancy , abortion , and live-birth rates . RESULT ( S ) Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy , live-birth , and abortion rates , whereas pregnancy and live-birth rates per cycle , and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group . Categorizing the patients according to surgical indication for myomectomy , cumulative pregnancy rate , pregnancy , and live-birth rates per cycle , and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients , whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility . CONCLUSION ( S ) Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility , whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas OBJECTIVE Our purpose was to investigate the advantages of laparoscopic myomectomy versus laparotomy . STUDY DESIGN A prospect i ve , r and omized trial was performed on 40 women , 22 to 44 years old , undergoing myomectomy .  Patients were r and omized to have laparoscopy ( n=20 ) or laparotomy ( n=20 ) . The intensity of pain was assessed by a visual analog scale at 0 , 1 , 2 , and 3 days postoperatively . The proportions of patients who were analgesic free on day 2 , discharged from the hospital by day 3 , and feeling fully recuperated on day 15 were also compared . RESULTS The intensity of postoperative pain was lower ( p<0.05 ) after laparoscopy than after laparotomy . A higher ( p<0.05 ) proportion of patients was analgesic free on day 2 , discharged from hospital by day 3 , and feeling fully recuperated on day 15 after laparoscopy compared with laparotomy . CONCLUSION Laparoscopic myomectomy may offer the benefits of lower postoperative pain and shorter recovery time in comparison with laparotomy OBJECTIVE Uterine leiomyoma , or fibroid tumors , are the leading indication for hysterectomy in the United States , but the proportion of women in whom fibroid tumors develop is not known . This study screened for fibroid tumors , independently of clinical symptoms , to estimate the age-specific proportion of black and white women in whom fibroid tumors develop . STUDY DESIGN R and omly selected members of an urban health plan who were 35 to 49 years old participated ( n = 1364 women ) .  Medical records and self-report were used to assess fibroid status for those women who were no longer menstruating ( most of whom had had hysterectomies ) . Premenopausal women were screened by ultrasonography . We estimated the age-specific cumulative incidence of fibroid tumors for black and white women . RESULTS Thirty-five percent of premenopausal women had a previous diagnosis of fibroid tumors . Fifty-one percent of the premenopausal women who had no previous diagnosis had ultrasound evidence of fibroid tumors . The estimated cumulative incidence of tumors by age 50 was > 80 % for black women and nearly 70 % for white women . The difference between the age-specific cumulative incidence curves for black and white women was highly significant ( odds ratio , 2.9 ; 95 % CI , 2.5 - 3.4 ; P < .001 ) . CONCLUSION The results of this study suggest that most black and white women in the United States develop uterine fibroid tumors before menopause and that uterine fibroid tumors develop in black women at earlier ages than in white women AIM To evaluate the efficacy and applicability of the minilaparotomy technique in  abdominal myomectomies  and to compare it with traditional laparotomy . METHODS We enrolled 99 women , suffering from symptomatic uterine myomas , to be operated for myomectomy .  Through computer r and omization , 55 women were assigned to the study group ( minilaparotomy )  and 44 women to the control group  ( traditional laparotomy ) . Women assigned to the study group were operated using a recently modified minilaparotomy technique . Statistical evaluation was performed through Mann-Whitney U test , chi2 test , Student 's t-test . RESULTS Duration of surgery , time for spontaneous recanalization and days of postoperative hospital stay were significantly lower in the study group , as well as treatment satisfaction reported by the patients ( p<0.05 ) . Moreover , each minilaparotomy operation ended by saving 620 Euro . CONCLUSIONS Minilaparotomy seems to be a valid alternative to the removal of symptomatic uterine myomas . The objective and subjective advantages in operated patients , as well as the reduction in sanitary costs are underlined Purpose Comparison between laparoscopically assisted myomectomy ( LAM ) and abdominal myomectomy ( laparotomy ) , used in the management of women with intramural or subserous uterine fibroids up to 90 mm of maximum diameter . Methods Seventy-five premenopausal women were prospect ively enrolled in the study , managed by LAM ( n = 48 ) or by laparotomy ( n = 27 ) approach . The short-term outcomes were compared between the two groups . The patient characteristics were also analyzed . Results The mean ( ±SD ) estimated blood loss was significantly less in the LAM procedure compared with laparotomy ( 246 ± 161 vs. 351 ± 219 ml , respectively , P = 0.03 ) . Similarly , the operative time was shorter in the LAM modality compared with laparotomy ( 68 ± 21 vs. 83 ± 24 min , respectively , P = 0.01 ) . Intraoperative and postoperative complications were not different between the two groups . The mean days of the bowel reactivity ( 1.04 ± 0.2 ) was faster ( P < 0.0001 ) , while the duration of hospitalization ( 1.2 ± 0.6 ) was shorter ( P < 0.0001 ) in the LAM technique , when compared with abdominal myomectomy ( 1.8 ± 0.5 and 4.2 ± 0.8 , respectively ) . Conclusions In selected group of patients , LAM as minimally invasive approach is an attractive alternative to conventional laparotomic myomectomy , offering significant advantages In a single-centre , r and omized trial , gasless laparoscopic myomectomy was compared with conventional laparoscopic myomectomy .  The study examined feasibility , safety , reliability and post-operative outcomes . Estimated blood loss , duration of surgery , early post-operative outcomes and length of hospital stay were recorded . Compared with conventional laparoscopic myomectomy , gasless laparoscopy result ed in significantly lower intra-operative blood loss ( median 100 ml vs 80 ml , respectively ) and duration of surgery ( median 94 min vs 71 min , respectively ) . Post-operative abdominal drainage volume was significantly lower after gasless laparoscopy than after conventional laparoscopy ( median 100 ml vs 240 ml ) . There was no significant difference between duration of post-operative fever , post-operative time to flatus or length of hospital stay . Both forms of laparoscopy are suitable for uterine myomectomy , and comparison of these methods showed that gasless laparoscopy had potential advantages over conventional laparoscopy STUDY OBJECTIVE To compare the postoperative recovery of patients undergoing laparoscopic and minilaparotomic myomectomy .  DESIGN R and omized study ( Canadian Task Force classification I ) . SETTING University hospital . PATIENTS One hundred forty-eight women requiring surgical myomectomy . INTERVENTIONS Myomectomy by minilaparotomy or laparoscopy . MEASUREMENTS AND MAIN RESULTS Operation time was significantly lower in the minilaparotomy group ( p < .001 ) . When compared with minilaparotomy , laparoscopy was associated with a lower decline of hemoglobin concentration ( p < .001 ) , a reduced length of postoperative ileus ( p < .001 ) , and a shorter time to discharge ( p < .001 ) . Pain intensity at 6 hours after surgery was significantly lower in the laparoscopy group ( p < .001 ) ; also , patients who underwent laparoscopy requested analgesics less frequently in the first 48 hours after the operation ( p < .001 ) . Patients included in the laparoscopy group were fully recuperated on postoperative day 15 more frequently than those included in the minilaparotomy group ( p = .012 ) . No complications were observed in the minilaparotomy group . There were two complications in the laparoscopy group ( one laparoconversion caused by difficulties of hemostasis and one acute diffuse peritonitis caused by ileal perforation ) . Laparoscopic and minilaparotomic myomectomy  cost , respectively , 2250 euros and 1975 euros . CONCLUSION When compared with minilaparotomic myomectomy , laparoscopic myomectomy may offer the benefits of lower postoperative analgesic use and faster postoperative recovery OBJECTIVE To retrospectively compare the feasibility , safety , morbidity , and pregnancy outcome of laparoscopy ( LPS ) and minilaparotomy ( LPT ) in the treatment of symptomatic uterine myomas . DESIGN Retrospective , nonr and omized study . SETTING Advanced Gynecological Endoscopy Center , Malzoni Medical Center , Avellino , Italy . PATIENT(S ) 680 nonconsecutive patients with symptomatic uterine myomas . INTERVENTION(S ) 350 women underwent LPS , and 330 underwent LPT myomectomy . MAIN OUTCOME MEASURE(S ) Operative time , blood loss , hospital stay , pregnancy rate , and spontaneous abortion rate . RESULT ( S ) The mean operative time was 63 + /- 21 minutes ( 95 % CI , 48 - 143 ) in the LPS group and 57 + /- 23 minutes ( 95 % CI , 38 - 121 ) in the LPT group . The mean length of hospital stay was statistically significantly greater in the LPT group ( 3.1 + /- 0.5 ; 95 % CI , 1 - 5 ) than the LPS group ( 2.1 + /- 0.8 ; 95 % CI , 1 - 4 ) . The overall spontaneous pregnancy rate after myomectomy was 53 % ; the pregnancy rate after LPS myomectomy ( 56 % ) was not statistically significantly higher than the rate for LPT ( 50 % ) . CONCLUSION ( S ) Laparoscopy showed a lower morbidity than reported for the open approach and was characterized by less blood loss and a shorter postoperative hospitalization with an higher pregnancy rate . The operating time was not much longer in the laparoscopic group , and the intraoperative and postoperative complications appeared acceptable and not more than what is traditionally expected with the open approach STUDY OBJECTIVE Comparison between laparoscopy and minilaparotomy in the management of intramural and /or subserosal uterine myomas . DESIGN Prospect i ve study ( Canadian Task Force classification II-2 ) . SETTING University hospital . PATIENTS Two hundred-thirteen women with at least one subserosal and /or intramural uterine myoma . INTERVENTION Laparoscopy and minilaparotomy myomectomy . MEASUREMENTS AND MAIN RESULTS We performed 213 myomectomies , 120 by minilaparotomy and 93 by laparoscopy .  Median number of myomas removed per patient was 1.4 ( range 1 - 3 ) and 2.9 ( range 1 - 5 ) in the laparoscopy and minilaparotomy groups , respectively ( p<.05 ) . The estimated blood loss was not significant in either of the two groups , 
    Output:
    
This indicates that among women undergoing laparoscopic myomectomy , the risk of postoperative fever is 50 % lower than among those treated with open surgery .
Laparoscopic myomectomy is a procedure associated with less subjectively reported postoperative pain , lower postoperative fever and shorter hospital stay compared with all types of open myomectomy .
No evidence suggested a difference in recurrence risk between laparoscopic and open myomectomy .