OBJECTIVE: To compare outcomes in patients with symptomatic uterine myomas who underwent laparoscopic (LPS) or minilaparotomic (MLPT) myomectomy. DESIGN: Prospective randomized study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Eighty patients with no more than 3 uterine myomas of maximal diameter of 7 cm. INTERVENTION: Either LPS or MLPT myomectomy. MEASUREMENTS AND MAIN RESULTS: Mean blood loss, mean duration of postoperative ileus, and mean decrease in hemoglobin were significantly lower in the LPS compared with the MLPT group (p < .001). Mean operative time was not significantly longer in the LPS group compared with the MLPT group. Duration of hospitalization was significantly shorter in the LPS compared with the MLPT group (p < .001). No intraoperative complications were observed during MLPT. In 1 patient, conversion from LPS to MLPT was necessary because of difficulty in reconstructing the uterine wall. CONCLUSION: Laparoscopic myomectomy is a suitable alternative to MLPT in women with 1 to 3 myomas. However, preoperative careful evaluation of the size and sites of the myomas is necessary to avert conversion and prevent complications.