Figure 2

Excision of bizarre leiomyoma by a gasless laparoscopic procedure with a wound retractor. (A) An en bloc enucleation was difficult because of a poorly defined border between the tumor and the surrounding myometrium. (B) Prominent myxomatous change (arrow) was noted. (C) Direct palpation through the wound retractor (arrow) was useful in determining the excision line. (D) After an excision of the bizarre leiomyoma, the uterine muscular layer was reapproximated by a two-layered closure.