Fig. 1.

Surgical procedures of MAH. This patient was a 46-year-old Japanese woman with multiple uterine leiomyomas. The largest leiomyoma was over 10 cm in diameter on admission and was reduced to 8 cm in diameter after three rounds of GnRHa administration. She had a history of one gravidity and one parity. The operation time was 99 minutes, and the blood loss was 292 ml. The vertical incision was made in the middle of the abdomen 3 cm above the pubes. We resected the uterus and both fallopian tubes and preserved both ovaries. The total weight of the resected specimens was 467 g. a The size of the skin incision was 4.5 cm. b Appearance of the wound with medium Alexis wound protector/retractor and vasopressin solution injection into the surface of the uterus. c After several cuts to reduce its diameter, the leiomyoma was grasped with sharp clamps and pulled through the wound. d Appearance of the enucleation of the leiomyomas and the removed uterus. e The cut to the uterine artery. f The sutured vaginal stump. g Appearance of the sutured skin wound. After extending the wound with the aforementioned wound retractor, the skin wound reached a final length of 5.0 cm. h Appearance of the resected uterus and both tubes