Uterine leiomyomas are the most common estrogen-dependent benign tumors in women of reproductive age [
1‐
4]. All gynecologists in local private clinics and major regional or university hospitals often encounter patients with this disease, and some of these patients will require operations. Because leiomyomas distort the uterine cavity, even relatively small ones may cause patients of reproductive age to have symptoms such as hypermenorrhea, decreased fertility, and increased miscarriage [
5,
6] . The risk of perinatal diseases, premature delivery, and placental abruption is considered to be increased in these patients [
7‐
9]. Therefore, many previous studies have concluded that large (over 5 cm in diameter) and multiple leiomyomas should be removed from women of reproductive age planning future pregnancy or childbirth [
10,
11]. Other than uterine artery embolization and hysteroscopic myomectomy, which are performed for patients with submucosal leiomyomas [
12,
13], almost all the interventions performed for women of reproductive age with leiomyomas are surgeries [
14]. Compared with other gynecological surgeries, most target patients are relatively young and inevitably request laparoscopic surgery because of its advantages, including superior aesthetic results, faster recovery, and a shorter hospital stay [
15,
16]. However, in addition to an increased risk of uterine wall damage during pregnancy caused by the difficulty of laparoscopic suturing procedures [
17,
18], long operative times are typical disadvantages of laparoscopic myomectomy [
19]. When sufficient hard and soft capacity are available at large hospitals, the choice of surgical technique depends directly on tumor characteristics, including size, number, and location as well as patient preferences. However, in Japan, most hospitals with an obstetrics and gynecology department, especially those in rural areas, have severely limited human resources because most gynecologists in Japan must manage deliveries. Under such circumstances, shorter operative times and fewer complications, especially massive blood loss, are much more important. When laparoscopic surgeries cannot be performed in their facilities, clinicians need to determine whether to refer patients to large hospitals with greater functionality. However, large hospitals have many patients waiting for surgical treatment because a large number of patients visit these hospitals, exceeding their capabilities. For women of advanced reproductive age who want to give birth, it is especially important to eliminate the long period between diagnosis and treatment to allow for the contraceptive period required after myomectomy. Thus, it is important to provide accurate and varied information to help patients select their treatment methods, although recently, most clinicians have begun to pay great attention to the advantages of laparoscopic surgeries or other cutting-edge technologies. Therefore, we introduce our minimal skin incision laparotomy technique for leiomyomas, which offers improvements on classical abdominal myomectomy. In this procedure, we attempted to make the abdominal wound as small as possible, with a maximum length of approximately 5 cm. In this retrospective analysis of patients who wished to preserve their uterus and underwent myomectomy, we tried to identify the optimal application of our surgical method in terms of decreased operative time and reduced blood loss.