STUDY OBJECTIVE: Comparison between laparoscopy and minilaparotomy in the management of intramural and/or subserosal uterine myomas. DESIGN: Prospective 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, and no intraoperative or early postoperative complications were registered. The median operating time was 62.3 minutes (range 45-80 min) and 61.6 minutes (range 40-90 min) in the laparoscopy and minilaparotomy groups, respectively (p=NS). Median duration of ileus was 1.4 days (range 1-2) in the laparoscopy group and 1.3 days (range 1-2 days) in the minilaparotomy group (p=NS). Median length of hospital stay was 2.3 days (range 2-3 days) and 2.8 days (range 2-3 days) in the laparoscopy and minilaparotomy groups, respectively (p=NS.). CONCLUSION: Myomectomy by minilaparotomy can be considered a minimally invasive alternative to laparoscopy in the surgical management of intramural and subserosal myomas.